Perkutane extrakorporale Zirkulation bei kardiogenem Schock aufgrund einer Mischintoxikation mit Metildigoxin, Nifedipin und Indapamid

Schmidt, W.; Reissig, M.; Neuhaus, K.-L.

doi:10.1055/s-2008-1055437

Cited by 4 publications

(1 citation statement)

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“…There is no further need for anti-arrhythmics, endocardial pacemakers or even ECLS, which had been used in the past [ 14 , 15 ], providing that digoxin-specific Fab fragments are available [ 15 ]. However, the future of immunotherapy in the treatment of other cardiotoxic drug poisonings still remains uncertain.…”

Section: Drug-induced Cardiovascular Shock: a Leading Cause Of Deathmentioning

confidence: 99%

Clinical review: Aggressive management and extracorporeal support for drug-induced cardiotoxicity

et al. 2007

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Poisoning may induce failure in multiple organs, leading to death. Supportive treatments and supplementation of failing organs are usually efficient. In contrast, the usefulness of cardiopulmonary bypass in drug-induced shock remains a matter of debate. The majority of deaths results from poisoning with membrane stabilising agents and calcium channel blockers. There is a need for more aggressive treatment in patients not responding to conventional treatments. The development of new antidotes is limited. In contrast, experimental studies support the hypothesis that cardiopulmonary bypass is life-saving. A review of the literature shows that cardiopulmonary bypass of the poisoned heart is feasible. The largest experience has resulted from the use of peripheral cardiopulmonary bypass. However, a literature review does not allow any conclusions regarding the efficiency and indications for this invasive method. Indeed, the majority of reports are single cases, with only one series of seven patients. Appealing results suggest that further studies are needed. Determination of prognostic factors predictive of refractoriness to conventional treatment for cardiotoxic poisonings is mandatory. These prognostic factors are specific for a toxicant or a class of toxicants. Knowledge of them will result in clarification of the indications for cardiopulmonary bypass in poisonings. IntroductionFailure of various organs may result in the death of acutely poisoned patients. In the 1960s, sedative-induced respiratory failure was the leading cause of death in Western countries. In these cases, endotracheal intubation and mechanical ventilation dramatically improved the prognosis. Similarly, renal replacement therapy with dialysis prevents deaths related to toxicant-induced acute renal failure. Even druginduced fulminant liver failure is successfully treated in selected cases by liver transplantation. In contrast, the usefulness of temporary mechanical assistance in druginduced cardiac failure still remains a matter of debate [1,2].However, promising results have been obtained using a combination of percutaneous cardiopulmonary support and cardiac resuscitation [3,4]. Furthermore, a recent report of the first series of acute poisonings treated with extracorporeal life support (ECLS) [5], together with an increasing number of case reports [6-10], suggests it is necessary to define the place of this aggressive treatment for drug-induced cardiotropic toxicity. Drug-induced cardiovascular shock: a leading cause of deathOver the past 30 years, improvements in the treatment of drug-induced cardiovascular shock have been due mainly to a better understanding of the different mechanisms of shock. Routine bedside haemodynamic examinations have provided evidence of the different mechanisms of drug-induced cardiovascular shock, which has enabled the selection of drugs to address the different components of shock. Within the same period of time, indications for mechanical ventilation were extended to conscious poisoned patients presenting ...

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Section: Drug-induced Cardiovascular Shock: a Leading Cause Of Deathmentioning

confidence: 99%