A Review of Emergency Cardiopulmonary Bypass for Severe Poisoning by Cardiotoxic Drugs

Johnson, Nicholas J.; Gaieski, David F.; Allen, Steven R.; Perrone, Jeanmarie; DeRoos, Francis

doi:10.1007/s13181-012-0281-8

Cited by 59 publications

(57 citation statements)

References 47 publications

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“…The use of ECMO prior to cardiovascular collapse in the majority of our patients may have led to improved overall survival. A case series of 62 patients in France showed similar survival rates of 76 % in patients receiving ECMO due to severe acute drug intoxication with a lower overall mortality rate when compared to patients who received supportive care alone [26,27]. In this study, 10 of 62 patients were in persistent cardiac arrest when ECMO was initiated.…”

Section: Discussionmentioning

confidence: 51%

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: 51%

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

et al. 2015

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“…Veno-venous ECMO requires less heparin than veno-arterial ECMO, thus reducing mortality from bleeding. ECMO was reported in several cases of CCBs poisoning [8][9][10], in all of them veno-arterial ECMO was used because of cardiovascular collapse. This is unlike our case where veno-venous ECMO was used due to ARDS.…”

Section: Discussionmentioning

confidence: 99%

“…Few case reports described the successful use of extracorporeal membrane oxygenation (ECMO) for CCBs poisoning [8][9][10]. Only one case report of ECMO used for ILE-induced ARDS was published [11], the procedure was veno-arterial ECMO, not veno-venous.…”

Section: Introductionmentioning

confidence: 99%

Acute Respiratory Distress Syndrome Associated with Intravenous Lipid Emulsion Therapy for Verapamil Toxicity, Successfully Treated with Veno-Venous ECMO

Friedman¹,

Feld²,

Adler³

et al. 2017

J Dev Drugs

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Calcium channel blocker (CCB) overdose is a potentially fatal poisoning. The use of intravenous lipid emulsion (ILE) therapy for CCB poisoning has emerged in the past few years. In 2017, the American College of Medical Toxicology published interim guidance for the use of ILE resuscitation in these cases. We report an uncommon complication of ILE, acute respiratory distress syndrome, treated with veno-venous extracorporeal membrane oxygenation (ECMO).Case report: A 40-year-old hypertensive woman presented with shock (blood pressure 62/34 mmHg, pulse 86/ min) following ingestion of 4,800 mg verapamil slow release and 1,500 mcg clonidine during a suicide attempt. She was treated with calcium gluconate, sodium bicarbonate, IV high dose insulin, IV glucagon, cardiac amines and vasopressors without response (blood pressure 69/37 mmHg, pulse 78/min). ILE was initiated, and two hours later, she developed acute respiratory failure necessitating intubation and mechanical ventilation. Due to poor oxygenation (pO 2 44 mmHg; FiO 2 100%) emergent veno-venous ECMO was instituted. After one hour her blood pressure increased to 104/50 mmHg (pulse 80, pO 2 75 mmHg), and continued so until weaning from ECMO and ventilation. Conclusion:Acute respiratory distress syndrome can be a major life threating complication following ILE; venovenous ECMO is suggested for its treatment.

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“…The clinical spectrum of poisoning from cardiotoxic drugs is broad encompassing life-threatening cardiac arrhythmias, hypotension or even cardiogenic shock and cardiac failure remains a leading cause of death (2).…”

Section: Introductionmentioning

confidence: 99%

“…The analysis of the scientific literature shows a paucity of data about the use of ECLS in cardiotoxic drugs poisoning and, to the best of our knowledge, the majority of the published studies on this topic are case reports (2) or case series with a small number of patients (5)(6)(7)(8). So, the aim of this report is to present the results of ECLS in the setting of drug intoxication in a single-center experience.…”

Section: Introductionmentioning

confidence: 99%

High rate of arterial complications in patients supported with extracorporeal life support for drug intoxication-induced refractory cardiogenic shock or cardiac arrest

Pozzi¹,

Koffel²,

Djaref³

et al. 2017

J. Thorac. Dis.

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Background: Cardiac failure is still a leading cause of death in drug intoxication. Extracorporeal life support (ECLS) could be used as a rescue therapeutic option in patients developing refractory cardiogenic shock or cardiac arrest. The aim of this report is to present our results of ECLS in the setting of poisoning from cardiotoxic drugs. Methods: We included in this analysis consecutive patients who received an ECLS for refractory cardiogenic shock or in-hospital cardiac arrest due to drug intoxication. The primary endpoint of our study was survival to hospital discharge with good neurological recovery after ECLS support. Results: Between January 2010 and December 2015, we performed 12 ECLS. Mean age was 44.2±17.8 years and there was a predominance of females (66.7%). Drug intoxication was mainly due to beta-blockers and/or calcium channel inhibitors (83.3%) and 5 (41.7%) patients had multiple drugs overdose. Weaning rate and survival to hospital discharge with good neurological recovery were 75% (9 patients). Among patients weaned from ECLS, mean duration of support was 2.4±1.1 days. Three (25%) patients underwent ECLS implantation during cardiopulmonary resuscitation, 2 (66.6%) of them died while on mechanical circulatory support (MCS). Six (50%) patients developed lower limb ischemia. Each patient was managed with ECLS decannulation: 2 (16.7%) patients underwent a concomitant iliofemoral thrombectomy, 3 (25%) needed further fasciotomy and the remaining patient (8.3%) required an amputation. Conclusions: Refractory cardiogenic shock due to drug intoxication is still one of the best indications for ECLS owing to the satisfactory survival with good neurological outcome in such a critically ill population.Further data are however necessary in order to best understand the possible relation between drug intoxication and lower limb ischemia, which was quite superior to the reported rates.

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A Review of Emergency Cardiopulmonary Bypass for Severe Poisoning by Cardiotoxic Drugs

Cited by 59 publications

References 47 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)

Acute Respiratory Distress Syndrome Associated with Intravenous Lipid Emulsion Therapy for Verapamil Toxicity, Successfully Treated with Veno-Venous ECMO

High rate of arterial complications in patients supported with extracorporeal life support for drug intoxication-induced refractory cardiogenic shock or cardiac arrest

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