Background <p>Hydrofluoric acid poisoning can cause severe hypocalcemia and hypomagnesemia, which may subsequently lead to ventricular arrhythmias. This report describes a 52-year-old male patient who developed refractory ventricular fibrillation following hydrofluoric acid ingestion, which led to cardiogenic shock. After receiving veno-arterial extracorporeal membrane oxygenation (VA-ECMO) as an adjunctive therapy, the patient recovered well and was ultimately discharged.</p> Case presentation <p>A 52-year-old male developed persistent ventricular fibrillation (VF) after ingesting 50 mL of industrial hydrofluoric acid solution. The medical team promptly initiated VA-ECMO support, which successfully stabilized the patient from a life-threatening condition. However, on the ninth day after ingestion, the patient developed gastrointestinal bleeding. Gastroscopy revealed multiple esophageal ulcers with active bleeding. Through timely hemostatic interventions and blood transfusion therapy, the patient demonstrated significant clinical improvement, including stabilization of hemoglobin levels and cessation of bleeding.</p> Conclusions <p>Ingestion of hydrofluoric acid through the digestive tract can cause malignant arrhythmias. Early administration of VA-ECMO as an adjunctive therapy may be life-saving in severe cases. Gastrointestinal symptoms caused by hydrofluoric acid poisoning may not be apparent in the early stages; however, there is a risk of recurrent gastrointestinal bleeding in later stages. This case offers a valuable reference for the treatment of hydrofluoric acid ingestion.</p>