Extracorporeal Membrane Oxygenation for Poisonings Reported to U.S. Poison Centers from 2000 to 2018: An Analysis of the National Poison Data System*

Abstract

Objectives: To assess trends in the use of extracorporeal membrane oxygenation for poisoning in the United States. Design: Retrospective cohort study. Setting: The National Poison Data System, the databased owned and managed by the American Association of Poison Control Centers, the organization that supports and accredits all 55 U.S. Poison Centers, 2000–2018. Patients: All patients reported to National Poison Data System treated with extracorporeal membrane oxygenation. Interventions: None. Measurements and Main Results: In total, 407 patients met final inclusion criteria (332 adults, 75 children). Median age was 27 years (interquartile range, 15–39 yr); 52.5% were male. Median number of ingested substances was three (interquartile range, 2–4); 51.5% were single-substance exposures. Extracorporeal membrane oxygenation use in poisoned patients in the United States has significantly increased over time (z = 3.18; p = 0.001) in both adults (age > 12 yr) and children (age ≤ 12 yr), increasing by 9–100% per year since 2008. Increase in use occurred more commonly in adults. We found substantial geographical variation in extracorporeal membrane oxygenation use by geospatially mapping the ZIP code associated with the initial call, with large, primarily rural areas of the United States reporting no cases. Overall survival was 70% and did not vary significantly over the study period for children or adults. Patients with metabolic and hematologic poisonings were less likely to survive following extracorporeal membrane oxygenation than those with other poisonings (49% vs 72%; p = 0.004). Conclusions: The use of extracorporeal membrane oxygenation to support critically ill, poisoned patients in the United States is increasing, driven primarily by increased use in patients greater than 12 years old. We observed no trends in survival over time. Mortality was higher when extracorporeal membrane oxygenation was used for metabolic or hematologic poisonings. Large, predominantly rural regions of the United States reported no cases of extracorporeal membrane oxygenation for poisoning. Further research should focus on refining criteria for the use of extracorporeal membrane oxygenation in poisoning.

Hydroxocobalamin and extracorporeal membrane oxygenation (ECMO) for severe refractory shock in bupropion and citalopram overdose: a case report

“…According to data published in 2018 by the Association of Poison Control Centers' National Poison Data System (NPDS), antidepressant exposures over the past 10 years have increased rapidly with the most frequently reported poisonings being bupropion and citalopram, with 14,824 and 8,169 cases respectively [3]. In another review, looking at ECMO cases reported to the NPDS, bupropion was the most common antidepressant in single-ingestion cases, further illustrating the seriousness of bupropion overdoses [1].…”

“…Management of bupropion and citalopram poisonings remain largely supportive, though more invasive treatments have begun to emerge, such as ECMO [1]. Once conventional therapies with vasopressors and lipid emulsion (Intralipid ®, Baxter Healthcare Corp., Deerfield IL) failed to mitigate worsening multifaceted shock, our patient was given hydroxocobalamin, to temporarily alleviate vasoplegia, and placed on VA ECMO.…”

Performance of extracorporeal membrane oxygenation in patients with fatal paraquat poisoning: grasp for straws?

“…Previous studies have shown that ECMO has attracted more attention in severe poisoning, such as through irritant gases, PQ, and aluminum phosphide. [6][7][8] E CMO can preserve tissue perfusion by augmenting oxygenated venous blood via V-V ECMO, enhancing perfusion to critical organs, and improving oxygenation via V-A ECMO. L ung transplantation may be the most effective end-stage therapy, owing to irreversible pulmonary fi brosis induced by PQ, in which ECMO can be the transitional supportive therapy.…”

Yellow Oleander (Thevetia peruviana), a source of toxic cardiac glycosides, may be substituted for candlenuts (Aleurities moluccana) when taken as a weight-loss supplement

“…Furthermore, more invasive treatments, such as extracorporeal membrane oxygenation (ECMO) should be considered if profound shock or cardiac arrest develops (particularly if sufficient antibody doses are not immediately available), as ECMO has been successfully used to treat digoxin poisoning. 5 Again, we thank O'Brien and colleagues for highlighting their important case, and encourage other clinicians who encounter patients purporting to have taken candlenuts with cardiac symptoms to consider yellow oleander poisoning in their differential diagnosis.…”