Outcome of patients supported by extracorporeal membrane oxygenation for aluminum phosphide poisoning: An observational study

Mohan, Bishav; Singh, Bhupinder; Gupta, V.; Ralhan, Sarju; Gupta, Dhiraj; Puri, Sandeep; Goyal, Abhishek; Aslam, Naved; Tandon, Rohit; Wander, Gurpreet Singh

doi:10.1016/j.ihj.2016.03.024

Cited by 46 publications

(44 citation statements)

References 20 publications

(24 reference statements)

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“…Moreover, Masson et al found a statistically significant survival benefit in ECLS-treated cardiotoxic drugs poisonings as compared to the conventional treatment (7). Mohan and coworkers reached the same conclusions in a comparative analysis of ECLS and standard supportive care in a population of drug intoxications caused by aluminium phosphide (8). Our results are consistent with these previous experiences as ECLS offered a survival to hospital discharge with good neurological recovery of 75%.…”

Section: Discussionsupporting

confidence: 89%

“…The small sample size is a limiting factor that could undermine the statistical power of our analysis. However our study population is comparable to that of previous articles of ECLS support for drug intoxication (5)(6)(7)(8). Our conclusions are gathered from a single-center observational experience and may not be representative of the general population.…”

Section: Limitations Of the Studymentioning

confidence: 54%

“…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%

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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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Section: Discussionsupporting

confidence: 89%

Section: Limitations Of the Studymentioning

confidence: 54%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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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“…[75] In another study, Mohan et al . [76] indicated that veno-arterial ECMO had a significant role in amelioration of toxicity and improvement of patient survival, principally for high-risk patients. It seems that a swift decision on using ECMO, before considerable reduction in ventricular ejection fraction, is pivotal for a reasonable response.…”

Section: Role Of Extracorporeal Membrane Oxygenation In Patients Suffmentioning

confidence: 99%

Thoughts on the current management of acute aluminum phosphide toxicity and proposals for therapy: An Evidence-based review

Farahani

Soroosh

Marashi

2016

Indian Journal of Critical Care Medicine

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The majority of aluminum phosphide (ALP) toxicity cases are suicidal attempts. Despite advances in critical care medicine, the mortality rate of ALP remains very high. Unfortunately, knowledge on the toxicokinetics of ALP is very low. An obsolete idea was proposed that inhibition of complex IV of cytochrome C oxidase is responsible for multiorgan dysfunction. However, based on human studies, this effect might be insignificant. Thus, a novel idea proposes that the main mechanism might be vascular wall integrity disruption. The low frequency of acute toxicity and unanswered questions about the toxicokinetics and toxicodynamics has led to leaden advances of novel treatments. The aim of this review was to evaluate problems regarding current treatment protocols and propose new ideas based on updated information. For this purpose, we reviewed all available articles on the management of ALP poisoning published to date. Considering failure of conventional therapies on maintaining systolic blood pressure, correcting acid-base disturbances, and support cardiac function, the previous treatment protocols have been overruled. However, repudiate of conventional treatments in this deadly condition is not without penalties for the health-care provider. The introduction of new therapies including refuse of gastric lavage with water-soluble compounds, administration of a high molecular weight colloidal solution for fluid resuscitation and termination using sodium bicarbonate, and vasoactive agents has been prospected to improve patient survival. This protocol is in early clinical evaluation; nevertheless, it appears to improve patient's survival; hence, future randomized trials should be performed to support their effectiveness.

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A study of the predictive factors of mortality in acute poisoning with aluminum phosphide with special reference to echocardiography and SOFA score

Sheta

El-Banna

Elmeguid

et al. 2019

Environ Sci Pollut Res

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Outcome of patients supported by extracorporeal membrane oxygenation for aluminum phosphide poisoning: An observational study

Cited by 46 publications

References 20 publications

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

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

Thoughts on the current management of acute aluminum phosphide toxicity and proposals for therapy: An Evidence-based review

A study of the predictive factors of mortality in acute poisoning with aluminum phosphide with special reference to echocardiography and SOFA score

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