Extracorporeal life support in severe drug intoxication: a retrospective cohort study of seventeen cases

Daubin, Cédric; Lehoux, Philippe; Ivascau, Calin; Tasle, Marine; Bousta, Mehdi; Lepage, Olivier; Quentin, Charlotte; Massetti, Massimo; Charbonneau, P.

doi:10.1186/cc8017

Cited by 107 publications

(105 citation statements)

References 34 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: 94%

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: 94%

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

et al. 2015

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“…ECLS is an effective rescue therapeutic option in refractory cardiogenic shock or cardiac arrest due to drug intoxication as previous articles reported an overall survival with good neurological recovery after ECLS support between 66% and 85% (2,(5)(6)(7)(8)19). Moreover, Masson et al found a statistically significant survival benefit in ECLS-treated cardiotoxic drugs poisonings as compared to the conventional treatment (7).…”

Section: Discussionmentioning

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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“…Therapy with ECMO was successfully applied for recovery, before heart transplantation or by default in patient in accidental hypothermia [19]. Promising results were also described in ECMO treated patients with cardiac failure after medicinal poisoning [14]. Aubron et al [20] point out that bleeding and coagulopathy are the most common complications in ECMO-treated patients, apart from neurological, vascular and infectious complications.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, there is a tendency to use VA ECMO as a treatment of choice for hypotermic patients [9][10][11][12][13]. Extracorporeal life support may be an effective treatment in patients developing cardiogenic shock due to drug poisoning, not responding to conventional therapy [14].…”

Section: Introductionmentioning

confidence: 99%

Veno-arterial extracorporeal membrane oxygenation for short-term mechanical circulation support in adults with cardiogenic shock: a single centre experience

Musiał

Moncznik

et al. 2016

Kardiol Pol

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A b s t r a c tBackground: Patients suffering from cardiogenic shock, with no response to conventional therapy, may significantly improve when put on support devices such as extracorporeal membrane oxygenation (ECMO), which maintains systemic and pulmonary circulation, and decongests the heart. This publication presents authors' own experience in qualifying and treating patients with cardiogenic shock, with the use of veno-arterial (VA) ECMO modality. Aim:The main goal of the study was to analyse factors influencing outcome of VA ECMO therapy in patients with cardiogenic shock. Survival data were compared for patients surviving treatment (n = 12, 41%), and for patients who died while VA ECMO. Methods:Retrospective study included all patients treated between February 2009, when ECMO was first used in the clinic, and March 2015. Of those, 29 patients were treated with VA ECMO for respiratory support. Mean patient age was 42 years; 19 (66%) patients were male, and 10 (34%) patients were female.Results: Total in-hospital mortality rate was 59% (17/29). No difference was observed as to patient age, sex, body height, mode of hospital admission, comorbidities or left ventricular ejection fraction at hospital admission, when comparing survivors and patients who died despite treatment. The following parameters were analysed: number of days on VA ECMO, troponin levels during first days from treatment onset, platelet transfusions, and duration of mechanical ventilation. No significant differences were observed between the groups. Surviving patients were significantly longer hospitalised (p = 0.016), including a longer stay in the intensive care unit (p = 0.03). Conclusions:VA ECMO is an acceptable therapy for patients in a severe state of cardiogenic shock. In-hospital mortality rate was 59%, and 41% patients (12 subjects) were successfully treated with VA ECMO in course of cardiogenic shock.

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Extracorporeal life support in severe drug intoxication: a retrospective cohort study of seventeen cases

Abstract: Introduction Cardiovascular failure is the leading cause of death in severe acute drug intoxication. In this setting, we report the feasibility, complications, and outcome of emergency extracorporeal life support (ECLS) in refractory shock or cardiac arrest following a drug overdose.

Cited by 107 publications

References 34 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)

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

Veno-arterial extracorporeal membrane oxygenation for short-term mechanical circulation support in adults with cardiogenic shock: a single centre experience

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