Percutaneous cardiopulmonary bypass for therapy resistant cardiac arrest from digoxin overdose

Behringer, Wilhelm; Sterz, Fritz; Domanovits, Hans; Schoerkhuber, Waltraud; Hölzer, Michael; Foedinger, Manuela; Laggner, Anton N.

doi:10.1016/s0300-9572(98)00025-2

Cited by 38 publications

(13 citation statements)

References 15 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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“…Improvement in antidote circulation is an additional benefit of CPB; Fab fragments have been reported to have a clinical effect by one hour after the end of the infusion, and with CPB previously refractory ventricular fibrillation was terminated within 30 minutes of the infusion. 7 We found only one case of open CPB (which was successful); in the remainder the percutaneous femoral approach was used. The latter does not require the chest to be opened and can be performed in the presence of ongoing external chest compression.…”

Section: Discussionmentioning

confidence: 92%

“…This would permit hepatic detoxification over time 6 while providing reliable tissue perfusion and allowing sufficient antidote circulation. 7 Modalities that may be used include continuous cardiopulmonary resuscitation (CPR; manual or with a mechanical device), balloon counterpulsation, and cardiopulmonary bypass (CPB). 8 Emergency extracorporeal membrane oxygenation (ECMO) may also be used to provide adequate cardiac output and restore vital organ perfusion to allow clearance of the toxic metabolite in question.…”

mentioning

confidence: 99%

Treatment of poisoning induced cardiac impairment using cardiopulmonary bypass: a review

Purkayastha

Bhangoo²,

Athanasiou³

et al. 2006

Emergency Medicine Journal

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“…oleander) toxicity is well established 36,37 . Digoxin Fab can also be administered in cardiac arrest from cardiac glycoside poisoning and has resulted in return of spontaneous circulation in this setting 38 . In cardiac arrest secondary to digitoxicity, digoxin antibody fragments should be administered as a bolus of 2–10 vials (each vial being 38 mg) intravenously over 30 min.…”

Section: Extra‐ordinary Resuscitative Measuresmentioning

confidence: 99%

Management of cardiac arrest following poisoning

Gunja

Graudins

2011

Emergency Medicine Australasia

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Toxic cardiac arrest is an uncommon manifestation of poisoning. Patients might benefit from resuscitative measures that are over and above those recommended in standard ACLS resuscitation guidelines. Extraordinary resuscitative measures might include the use of toxin-specific antidotes, prolonged CPR and/or other measures to bypass the poisoned myocardium (such as extra-corporeal membrane oxygenation). Treating medical staff should seek expert advice from a toxicologist or from their Poisons Information Centre network (Australia 13 11 26; New Zealand 0800 764 766) at the earliest opportunity when managing patients with cardiac arrest or intractable shock from known or suspected poisoning. Ideally, toxicological expertise should be sought before the withdrawal of active treatment in cardiac arrest or shock from known or suspected poisoning.

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Percutaneous cardiopulmonary bypass for therapy resistant cardiac arrest from digoxin overdose

Cited by 38 publications

References 15 publications

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

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

Treatment of poisoning induced cardiac impairment using cardiopulmonary bypass: a review

Management of cardiac arrest following poisoning

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