Toxic cardiac arrest is an uncommon manifestation of poisoning. Patients might benefit from resuscitative measures that are over and above those recommended in standard ACLS resuscitation guidelines. Extraordinary resuscitative measures might include the use of toxin-specific antidotes, prolonged CPR and/or other measures to bypass the poisoned myocardium (such as extra-corporeal membrane oxygenation). Treating medical staff should seek expert advice from a toxicologist or from their Poisons Information Centre network (Australia 13 11 26; New Zealand 0800 764 766) at the earliest opportunity when managing patients with cardiac arrest or intractable shock from known or suspected poisoning. Ideally, toxicological expertise should be sought before the withdrawal of active treatment in cardiac arrest or shock from known or suspected poisoning.