A comparison of survival with and without extracorporeal life support treatment for severe poisoning due to drug intoxication

Masson, R; Colas, Vincent; Parienti, Jean‐Jacques; Lehoux, Philippe; Massetti, Massimo; Charbonneau, P.; Saulnier, F.; Daubin, Cédric

doi:10.1016/j.resuscitation.2012.03.028

Cited by 154 publications

(142 citation statements)

References 17 publications

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“…Metformin toxicity treated with ECMO has not been previously described. Nonpharmaceutical exposures involving ECMO as a treatment modality have been reported sparingly and include carbon monoxide, zinc chloride, arsenic, hydrocarbon pneumonitis, and taxus poisoning [28][29][30][31][32][33][34][35]. Several of the patients in our cohort were due to non-pharmaceutical exposures (bitter almonds/cyanide, carbon monoxide/smoke inhalation, and methanol).…”

Section: Discussionmentioning

confidence: 93%

Extracorporeal Membrane Oxygenation (ECMO) for Severe Toxicological Exposures: Review of the Toxicology Investigators Consortium (ToxIC)

et al. 2015

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Although there have been many developments related to specific strategies for treating patients after poisoning exposures, the mainstay of therapy remains symptomatic and supportive care. One of the most aggressive supportive modalities is extracorporeal membrane oxygenation (ECMO). Our goal was to describe the use of ECMO for toxicological exposures reported to the American College of Medical Toxicology (ACMT) Toxicology Investigators Consortium (Tox-IC). We performed a retrospective review of the ACMT ToxIC Registry from January 1, 2010 to December 31, 2013. Inclusion criteria included patients aged 0 to 89 years, evaluated between January 2010 through December 2013, and received ECMO for toxicological exposure. There were 26,271 exposures (60 % female) reported to the ToxIC Registry, 10 (0.0004 %) received ECMO: 4 pediatric (< 12 years), 2 adolescent (12-18 years), and 4 adults (>18 years). Time of initiation of ECMO ranged from 4 h to 4 days, with duration from 15 h to 12 days. Exposures included carbon monoxide/smoke inhalation (2), bitter almonds, methanol, and several medications including antihistamines (2), antipsychotic/ antidepressant (2), cardiovascular drugs (2), analgesics (2), sedative/hypnotics (2), and antidiabetics (2). Four ECMO patients received cardiopulmonary resuscitation (CPR) during their hospital course, and the overall survival rate was 80 %. ECMO was rarely used for poisoning exposures in the ACMT ToxIC Registry. ECMO was utilized for a variety of ages and for pharmaceutical and non-pharmaceutical exposures. In most cases, ECMO was administered prior to cardiovascular failure, and survival rate was high. If available, ECMO may be a valid treatment modality.

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Section: Discussionmentioning

confidence: 93%

Extracorporeal Membrane Oxygenation (ECMO) for Severe Toxicological Exposures: Review of the Toxicology Investigators Consortium (ToxIC)

et al. 2015

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“…ECLS may be used to provide cardiopulmonary support until the clinical effects of the intoxicating agent have resolved or until effective pharmacologic treatment. In a report of ten patients with refractory and prolonged druginduced cardiac arrest, 86% of patients who received ECPR survived, compared to 48% survival in the conventionallymanaged group (40).…”

Section: Etiology Of Cardiac Arrestmentioning

confidence: 98%

Extracorporeal cardiopulmonary resuscitation

Yam

McMullan

2017

Ann. Transl. Med.

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Extracorporeal life support (ECLS) is used for patients in isolated or combined cardiopulmonary failures. The use of ECLS to rescue patients with cardiac arrest that is refractory to conventional cardiopulmonary resuscitation has been shown to improve survival in many patient populations. Increasing recognition of the survival benefit associated with extracorporeal cardiopulmonary resuscitation (ECPR) has led to increased use of ECPR during the past decade. This review provides an overview of ECPR utilization; population-based clinical outcomes, resource utilization and costs associated this advanced form of life support therapy.

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“…Because the treatment protocol for calcium channel blocker intoxication is supported by low-quality evidence, the treatment regimen is determined according to the severity of symptoms, including high-dose insulin, intravenous calcium gluconate injection, intravenous glucagon injection, intravenous vasopressor infusion and lipid emulsion therapy (5). Furthermore, it has been reported that extracorporeal life support is associated with a survival benefit in the setting of multiorgan dysfunction, severe shock and/or cardiac arrest after diltiazem overdose (5,(10)(11)(12). Although our patient was managed conservatively, his clinical course was uneventful and the serum diltiazem concentration decreased on day 3 (35.9 ng/mL).…”

Section: Discussionmentioning

confidence: 72%

Ischemic Acute Tubular Necrosis due to Diltiazem Overdose

et al. 2016

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Diltiazem overdose has a high mortality rate due to cardiotoxicity associated with bradycardia and hypotension. A previous article reported that this type of overdose can cause acute tubular necrosis, which was not pathologically, but rather clinically, diagnosed. We herein report the case of a 55-year-old man who sustained nonoliguric acute kidney injury after taking 60 diltiazem tablets. A kidney biopsy performed six days after admission showed ischemic, not toxic, acute tubular necrosis. The patient's kidney function improved spontaneously. In this case report, we clarify the cause of renal impairment caused by diltiazem overdose pathologically. Physicians should therefore consider ischemic acute tubular necrosis as a cause of kidney injury in patients with diltiazem overdose.

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A comparison of survival with and without extracorporeal life support treatment for severe poisoning due to drug intoxication

Cited by 154 publications

References 17 publications

Extracorporeal Membrane Oxygenation (ECMO) for Severe Toxicological Exposures: Review of the Toxicology Investigators Consortium (ToxIC)

Extracorporeal Membrane Oxygenation (ECMO) for Severe Toxicological Exposures: Review of the Toxicology Investigators Consortium (ToxIC)

Extracorporeal cardiopulmonary resuscitation

Ischemic Acute Tubular Necrosis due to Diltiazem Overdose

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