The use of VV-ECMO in patients with drug dependencies

Stoyle, George; Fawcett, Peter; Malagon, Ignacio

doi:10.1007/s10047-018-1026-5

Cited by 3 publications

(5 citation statements)

References 17 publications

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“…Prior investigations involving drug and alcohol dependent patients on VV ECMO did not specify that the inciting underlying diagnosis be the result of an acute intoxication, rather that the patients have an ongoing history of substance use. 7 Similar to our baseline statistics, their drug-dependent group had a lower weight than their non-drug-dependent matched cohort. However, the duration of ECMO was increased by almost 2 days in that drug-dependent cohort, which stands in contrast to our findings.…”

Section: Discussionsupporting

confidence: 71%

“…A retrospective study by Stoyle and colleagues demonstrated a small increase in the number of complications in patients with a history of drug or alcohol dependency on VV ECMO compared to those without a history of dependency. 7 While there was no statistical difference in rates of survival, there have been a number of case reports, which demonstrate the effective use of VV ECMO in patients with drug-related respiratory collapse. The etiology of the respiratory compromise is varied, including opioids, cocaine, 8,9 and marijuana cigarettes laced with phencyclidine or formaldehyde.…”

Section: Intoxication and Overdose Should Not Preclude Veno-venous Ex...mentioning

confidence: 99%

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Intoxication and overdose should not preclude veno-venous extracorporeal membrane oxygenation

et al. 2020

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Introduction Acute intoxication (AI) related morbidity and mortality are increasing in the United States. For patients with severe respiratory failure in the setting of an acute ingestion, veno-venous extracorporeal membrane oxygenation (VV ECMO) can provide salvage therapy. The purpose of this study was to evaluate outcomes in patients with overdose-related need for VV ECMO. Methods: We performed a retrospective review of all patients admitted to a specialty VV ECMO unit between August 2014 and August 2018. Patients were stratified by those whose indication for VV ECMO was directly related to an acute ingestion (alcohol, illicit drug, or prescription drug overdose) and those with unrelated diagnoses. Demographics, pre-cannulation clinical characteristics, ECMO parameters, and outcomes data was collected and analyzed with parametric and non-parametric statistics as indicated. Results: 189 patients were enrolled with 27 (14%) diagnosed with AI. Patients requiring VV ECMO for an AI were younger, had lower median BMI and PaO2/FiO2, and higher RESP scores than non-AI patients (p = 0.002, 0.01, 0.03 and 0.01). There was no difference in pre-cannulation pH, lactate, or SOFA scores between the two groups (p = 0.24, 0.5, 0.6). There was no difference in survival to discharge (p = 0.95). Among survivors, there was no difference in ECMO time or hospital stay (p = 0.24, 0.07). Conclusion: We demonstrate no survival difference for patients with and without an AI-related need for VV ECMO. AI patients should be supported with VV ECMO when traditional therapies fail despite potential stigma against acceptance on referral.

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Section: Discussionsupporting

confidence: 71%

Section: Intoxication and Overdose Should Not Preclude Veno-venous Ex...mentioning

confidence: 99%

Intoxication and overdose should not preclude veno-venous extracorporeal membrane oxygenation

et al. 2020

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“…However, limited experience with the use of percutaneous ECMO in drug-dependent patients has resulted in longer hospital stays and higher rates of complications. [13] Another dilemma the team faced was whether it was ethically the right decision to put this patient on ECMO, knowing that she may face longer hospital stays and poorer postoperative outcomes. Additionally, ECMO would require the allocation of a perfusionist around the clock, which would inevitably result in reducing nearly half the elective and inpatient cardiac operations in our unit.…”

Section: Discussionmentioning

confidence: 99%

“…However, limited experience with the use of percutaneous ECMO in drug-dependent patients has resulted in longer hospital stays and higher rates of complications. [ 13 ]…”

Section: Discussionmentioning

confidence: 99%

Postcardiotomy extracorporeal membrane oxygenation for infective endocarditis in a patient with intravenous drug use and COVID-19 infection: An ethical dilemma

Jiang¹,

Mansour²,

Cunningham³

et al. 2022

Turk Gogus Kalp Dama

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In this report, we present a case of native valve infective endocarditis due to active intravenous drug use in a 29-yearold female patient that presented during the peak of the coronavirus disease 2019 (COVID-19) pandemic. The patient underwent a complex cardiac surgical intervention with aortic valve replacement and mitral valve repair. Postcardiotomy extracorporeal membrane oxygenation (ECMO) support was required due to severe biventricular dysfunction. In this unprecedented situation, multiple ethical dilemmas arose at different stages in the management of this patient. These dilemmas stemmed from the lack of evidence supporting the use of postcardiotomy ECMO in patients with active intravenous drug use and the scarcity of resources due to the COVID-19 pandemic, resulting in pressure put on our healthcare system. In this case report, we present the decisions made by our team, taking into account both the patient"s best interests and the available resources. We hope this decision-making process will serve as a valuable learning experience for other teams and will act as an antecedent for similar situations in the future.

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“…In this group, civilisation diseases are rare, and if they do additionally occur, they significantly reduce patients' overall chances of survival. In the case of alcoholics, the presence of severe chronic hepatic insufficiency or advanced mental disorders is often sufficient to abandon any invasive procedures [34]. As a result of these circumstances, AD patients are unlikely to be qualified for more sophisticated and invasive ICU procedures.…”

Section: Discussionmentioning

confidence: 99%

Analysis of Patients with Alcohol Dependence Treated in Silesian Intensive Care Units

Łowicka-Smolarek

Kokoszka-Bargieł²,

Knapik

et al. 2022

IJERPH

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Analysis of patients with alcohol dependence (AD) treated in intensive care units has never been performed in Poland. Data from 25,416 adult patients identified in a Silesian Registry of Intensive Care Units were analysed. Patients with AD were identified, and their data were compared with the remaining population. Preadmission and admission variables that independently influenced ICU death in these patients were identified. Among 25,416 analysed patients, 2285 subjects (9.0%) were indicated to have AD among their comorbidities. Patients with AD were significantly younger (mean age: 53.3 ± 11.9 vs. 62.2 ± 15.5 years, p < 0.001) but had a higher mean APACHE II score at admission and were more frequently admitted to the ICU due to trauma, poisonings, acute pancreatitis, and severe metabolic abnormalities. ICU death and unfavourable outcomes were more frequent in these patients (47.8% vs. 43.0%, p < 0.001 and 54.1% vs. 47.0%, p < 0.001, respectively). Multiorgan failure as the primary cause of ICU admission was among the most prominent independent risk factors for ICU death in these patients (OR: 3.30, p < 0.001). Despite the younger age, ICU treatment of patients with AD was associated with higher mortality and a higher percentage of unfavourable outcomes.

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The use of VV-ECMO in patients with drug dependencies

Cited by 3 publications

References 17 publications

Intoxication and overdose should not preclude veno-venous extracorporeal membrane oxygenation

Intoxication and overdose should not preclude veno-venous extracorporeal membrane oxygenation

Postcardiotomy extracorporeal membrane oxygenation for infective endocarditis in a patient with intravenous drug use and COVID-19 infection: An ethical dilemma

Analysis of Patients with Alcohol Dependence Treated in Silesian Intensive Care Units

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