Extracorporeal life support in cardiotoxicant poisoning—A narrative review

Abstract

Extracorporeal life support (ECLS) improves circulation in life‐threatening cardiac dysfunction or arrest patients. Its benefits in drug‐induced cardiovascular complications are debated. Indications and outcomes are poorly established. We performed a narrative review discussing ECLS indications, timing and results in cardiotoxicant‐poisoned patients. The review was focused on antiarrhythmic drugs and aluminium phosphide. Literature analysis was limited to the past 30 years in adults. Most reports were single cases and retrospective except one prospective case series of limited size, two of them controlled. ECLS indications and timing were at the discretion of physicians in charge but mostly included persistent cardiovascular failure despite elevated doses of inotropic/vasopressor support associated with elevated blood lactate concentrations (usually, >5 mmol/L) and collapsed left ventricular ejection fraction (LVEF; usually, ≤40%). Survival improved using ECLS versus standard care in one study. Survival was ~80% if ECLS was implemented in refractory cardiovascular failure and 25%–66% if implemented in cardiac arrest. In two controlled studies, survival of ECLS‐treated aluminium phosphide‐poisoned patients was improved versus standard care, if implemented in the presence of systolic blood pressure ≤80 mmHg despite inotropic/vasopressor treatment, arterial pH ≤ 7.0 and LVEF ≤ 40%. Despite low‐to‐moderate level of evidence, ECLS seems effective to improve survival in selected cardiotoxicant‐poisoned patients. Selection criteria need clarification.

Extracorporeal cardio-pulmonary resuscitation in poisoning: A scoping review article

“…The Extracorporeal Life Support Organization (ELSO) defines ECPR as the application of rapidly-deployed veno-arterial extracorporeal membrane oxygenation (ECMO) in patients in whom conventional CPR is unsuccessful in achieving sustained return of spontaneous circulation (ROSC) 3 . As Voicu et al (2022) pointed out in a most recent review article, the indications, timing and outcomes for ECLS in cardiotoxic poisoning – least to say the role of ECPR in poisoning-induced cardiac arrest – remain speculative due to the limited data, heterogeneity and multi-drug nature of most poisonings, and the fact that conducting randomized human trials is virtually impossible 4 .…”