Predicting factors for the need of extracorporeal membrane oxygenation for suicide attempts by cardiac medication: a single-center cohort study

Abstract

BACKGROUND: Severe poisoning due to the overdosing of cardiac drugs can lead to cardiovascular failure. In order to decrease the mortality rate, the most severe patients should be transferred as quickly as possible to an extracorporeal membrane oxygenation (ECMO) center. However, the predictive factors showing the need for venous-arterial ECMO (VA-ECMO) had never been evaluated.METHODS: A retrospective, descriptive, and single-center cohort study. All consecutive patients admitted in the largest ICU of Reunion Island (Indian Ocean) between January 2013 and September 2018 for beta-blockers (BB), calcium channel blockers (CCB), renin-angiotensin-aldosterone system blockers, digoxin or anti-arrythmic intentional poisonings were included. ECMO implementation was the primary outcome.RESULTS: A total of 49 consecutive admissions were included. Ten patients had ECMO, 39 patients did not have ECMO. Three patients in ECMO group died, while no patients in the conventional group died. The most relevant ECMO-associated factors were pulse pressure and heart rate at first medical contact and pulse pressure, heart rate, arterial lactate concentration, liver enzymes and left ventricular ejection fraction (LVEF) at ICU-admission. Only pulse pressure at first medical contact and LVEF were significant after logistic regression.CONCLUSION: A transfer to an ECMO center should be considered for a pulse pressure < 35 mmHg at first medical contact or LVEF < 20% on admission to ICU.

Calcium Channel Blocker Overdose: What Role Does Extracorporeal Membrane Oxygenation Have in Support? A Systematic Review of the Literature

“…Vandroux et al . 17 demonstrated in their cohort of cardiogenic shock secondary to overdose a pulse pressure of < 35 at first point of medical evaluation and an LVEF < 20% on arrival to the ICU were both indicative of the likely need for ECLS support.…”

Approach to traumatic cardiac arrest in the emergency department: a narrative literature review for emergency providers

“…ECLS, commonly known as extracorporeal membrane oxygenation (ECMO), is a well-known technique used to provide support in cases of respiratory and cardiac failure. [47] The use of veno-venous (V-V) ECMO in trauma in the setting of acute lung injury and refractory hypoxemia is well reported. The first description of V-V ECLS in a case of blunt trauma was in 1972.…”