Extracorporeal Membrane Oxygenation and Cardiopulmonary Bypass in the Poisoned Patient

The Recommendation and Use of Extracorporeal Membrane Oxygenation (ECMO) in Cases Reported to the California Poison Control System

“…The oxygenated blood is then warmed to appropriate body temperature and pumped back into the body. This bypass of the heart, lungs, or both allows these organs to recover from toxic insult and still maintain the delivery of nutrients and oxygenated blood to all tissues while allowing continual elimination of toxins [2].…”

“…In VV ECMO, blood is withdrawn peripherally from a large vein (femoral, internal jugular, or subclavian) or centrally from the right atrium, oxygenated and then returned through the same vein or atria. In VA ECMO, blood is withdrawn peripherally from a large vein or centrally from the right atrium and oxygenated, but is instead returned peripherally to a large artery (femoral or carotid) or centrally to the proximal ascending aorta [2]. VV ECMO is used in patients with pulmonary failure who are hemodynamically stable and do not need blood pressure support.…”

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

“…Thus far, no systematic review has focused on the role of ECPR specific to drug intoxication and evidence has been purely observational to date 5 . Herein lies the clinical dilemma: without a clear understanding of its optimal timing and indications, ECPR might be initiated either too early when ROSC might still have been possible with conventional CPR, exposing the patient unnecessarily to immense risks from such an invasive procedure; or too late, after the onset of irreversible end-organ and brain damage 6 .…”