Extracorporeal Life Support in a Case of Fatal Flecainide and Betaxolol Poisoning Allowing Successful Cardiac Allograft

Vivien, Benoît; Deye, Nicolas; Mégarbane, Bruno; Marx, J.-S.; Leprince, Pascal; Bonnet, Nicolas; Jacob, Laurent; Pavie, Alain; Baud, Frédéric J.; Carli, Pierre

doi:10.1016/j.annemergmed.2010.01.021

Cited by 26 publications

(16 citation statements)

References 17 publications

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“…These early studies showed improved mortality in models of lidocaine and amitriptyline poisoning [11,12]. Numerous human case reports and case series have since shown favorable outcomes although ECMO has been primarily used in poisonings involving pharmaceuticals such as antidysrhythmics and other cardiovascular medications, as well as tricyclic antidepressants [13][14][15][16][17][18][19][20][21][22][23][24][25]. Many of the pharmaceutical exposures in our cohort were similar to cases reported in the literature with most leading to cardiotoxicity or hemodynamic collapse (flecainide, diphenhydramine, and verapamil).…”

Section: Discussionmentioning

confidence: 99%

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: 99%

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

et al. 2015

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“…Venoarterial extracorporeal membrane oxygenation is an emerging support measure for acutely poisoned patients and demonstrates promise [8][9][10][11][12][13][14][15][16][17][18]. Providing adequate circulation restores vital organ perfusion, allowing for intrinsic drug metabolism and elimination [11].…”

Section: Contents Lists Available At Sciencedirectmentioning

confidence: 99%

“…Providing adequate circulation restores vital organ perfusion, allowing for intrinsic drug metabolism and elimination [11]. Current American Heart Association guidelines suggest consultation with a toxicologist specialist when managing refractory hypotensive, poisoned patients [19].…”

Section: Contents Lists Available At Sciencedirectmentioning

confidence: 99%

“…e l s e v i e r . c o m / l o c a t e / a j e m provides both circulatory and oxygenation support to restore perfusion in acutely poisoned patients, allowing for intrinsic metabolism and drug elimination [11]. Intralipid therapy is thought to act as a lipid extractor, whereas high-dose insulin therapy has shown to improve cardiac function after heart surgery and benefit β-adrenergic cardiotoxicity [1].…”

Section: Contents Lists Available At Sciencedirectmentioning

confidence: 99%

“…This illustrates the need for medical interventions that reduce mortality in this population [7]. In massive overdose, traditional therapies such as glucagon, atropine, and vasopressors are insufficient; and circulatory device support, as well as high-dose insulin and intralipid therapies, may be indicated [8][9][10][11][12][13][14][15][16]. Venoarterial extracorporeal membrane oxygenation (VA-ECMO)…”

mentioning

confidence: 98%

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