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

Wang, G S; Levitan, Richard M.; Wiegand, Timothy J.; Lowry, Jennifer A.; Schult, Rachel F.; Yin, Shengyan

doi:10.1007/s13181-015-0486-8

Cited by 71 publications

(68 citation statements)

References 40 publications

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“…Rhythm-related low cardiac output states may result from tachycardia-induced cardiomyopathy or the myocardial depressant effects of anti-arrhythmic medications ( 21 ). ECLS is also equal occasionally used to provide support for patients who experience cardiovascular collapse due to accidental or intentional poisoning ( 22 ) and for patients who experience life-threatening pulmonary hypertensive crises ( 23 ). The use of mechanical cardiac support in the management of end-stage heart failure has dramatically evolved during the past two decades.…”

Section: Indications For Cardiac Eclsmentioning

confidence: 99%

ECLS in Pediatric Cardiac Patients

et al. 2016

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Extracorporeal life support (ECLS) is an important device in the management of children with severe refractory cardiac and or pulmonary failure. Actually, two forms of ECLS are available for neonates and children: extracorporeal membrane oxygenation (ECMO) and use of a ventricular assist device (VAD). Both these techniques have their own advantages and disadvantages. The intra-aortic balloon pump is another ECLS device that has been successfully used in larger children, adolescents, and adults, but has found limited applicability in smaller children. In this review, we will present the “state of art” of ECMO in neonate and children with heart failure. ECMO is commonly used in a variety of settings to provide support to critically ill patients with cardiac disease. However, a strict selection of patients and timing of intervention should be performed to avoid the increase in mortality and morbidity of these patients. Therefore, every attempt should be done to start ECLS “urgently” rather than “emergently,” before the presence of dysfunction of end organs or circulatory collapse. Even though exciting progress is being made in the development of VADs for long-term mechanical support in children, ECMO remains the mainstay of mechanical circulatory support in children with complex anatomy, particularly those needing rapid resuscitation and those with a functionally univentricular circulation. With the increase in familiarity with ECMO, new indications have been added, such as extracorporeal cardiopulmonary resuscitation (ECPR). The literature supporting ECPR is increasing in children. Reasonable survival rates have been achieved after initiation of support during active compressions of the chest following in-hospital cardiac arrest. Contraindications to ECLS have reduced in the last 5 years and many centers support patients with functionally univentricular circulations. Improved results have been recently achieved in this complex subset of patients.

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Section: Indications For Cardiac Eclsmentioning

confidence: 99%

ECLS in Pediatric Cardiac Patients

et al. 2016

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“…In 2016, 14 abstracts and five manuscripts using ToxIC Registry data were published and are listed on http://www. ToxICRegistry.org (Farrugia et al [2]; Beauchamp et al [3]; Judge et al [4]; Riederer et al [5]; Wang et al [6]).…”

Section: Introductionmentioning

confidence: 99%

The Toxicology Investigators Consortium Case Registry—the 2016 Experience

et al. 2017

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The Toxicology Investigators Consortium (ToxIC) Case Registry was established by the American College of Medical Toxicology in 2010. The Registry contains data from participating sites with the agreement that all bedside medical toxicology consultations will be entered. Currently, 83% of accredited medical toxicology fellowship programs in the USA participate. The Registry continues to grow each year, and as of 31 December 2016, a new milestone was reached, with more than 50,000 cases reported since its inception. The objective of this seventh annual report is to summarize the Registry's 2016 data and activity with its additional 8529 cases. Cases were identified for inclusion in this report by a query of the ToxIC database for any case entered from 1 January to 31 December 2016. Detailed data was collected from these cases and aggregated to provide information which includes the following: demographics (age, gender, race, ethnicity, HIV status), reason for medical toxicology evaluation (intentional pharmaceutical exposure, envenomation, withdrawal from a substance), agent and agent class, clinical signs and symptoms (vital sign abnormalities, organ system dysfunction), treatments and antidotes administered, fatality and life support withdrawal data. Fifty percent of cases involved females, and adults aged 19-65 were the most commonly reported. There were 86 patients (1.0%) with HIV-positive status known. Non-opioid analgesics were the most commonly reported agent class, with acetaminophen the most common agent reported. There were 126 fatalities reported in 2016 (1.5% of cases). Major trends in demographics and exposure characteristics remained similar overall with past years' reports. While treatment interventions were commonly required, fatalities were rare.

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“…Thus, ECMO should be reserved for critical patients who are at danger of impending death if they do not receive pertinent on‐time treatments. As an aggressive supportive modality, it has been used in treatment of other intoxications including carbon monoxide, bitter almonds, methanol and several medications such as antihistamines, antipsychotic/antidepressant, cardiovascular medications, analgesics, sedative/hypnotics and antidiabetics .…”

Section: Discussionmentioning

confidence: 99%

Successful Treatment of Aluminium Phosphide Poisoning by Extracorporeal Membrane Oxygenation

Hassanian‐Moghaddam

Zamani

Rahimi

et al. 2015

Basic Clin Pharma Tox

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Aluminium phosphide (ALP) is one of the most commonly used pesticides worldwide with high mortality rates. Cellular damage and cardiorespiratory failure are the most common causes of mortality and morbidity after poisoning. It is supposed that giving enough time to the patient to survive, the most critical hours after exposure may help the cardiovascular system to recover itself and save the patient's life. During a training workshop for medical extracorporeal membrane oxygenation (ECMO), a 28-year-old ALP-poisoned male was referred to us. Fifty minutes after admission, he developed hypotension and bradycardia and was transferred to ICU. On the second venous blood gas, he had severe metabolic acidosis. After starting the patient on the routine treatment of ALP poisoning, he was a candidate for veno-arterial (VA) ECMO. After three days, lactate level decreased and his general condition improved. On day four, the patient was completely separated from the ECMO machine with acceptable echocardiography and ejection fraction of 40%. One day later, he was extubated, sent to the ward and subsequently discharged in good condition. We suggest this method of treatment for severe ALP poisoning as well as any other poisoning that causes cell toxicity and abrupt cardiovascular or respiratory failure.

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

Cited by 71 publications

References 40 publications

ECLS in Pediatric Cardiac Patients

ECLS in Pediatric Cardiac Patients

The Toxicology Investigators Consortium Case Registry—the 2016 Experience

Successful Treatment of Aluminium Phosphide Poisoning by Extracorporeal Membrane Oxygenation

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