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

Abstract

Introduction Antidotes are available to treat some specific poisonings; however, the mainstay of treatment for the poisoned patient remains supportive care. Extracorporeal membrane oxygenation (ECMO) is one of the most aggressive supportive measures available to manage poisoned patients. Objective To characterize the recommendation and use of ECMO in cases reported to the California Poison Control System (CPCS). Methods This retrospective chart review queried the CPCS database from 1997 to 2016 for cases containing the American Association of Poison Control Centers (AAPCC) code for ECMO, and BECMO^and BECLS^free-text searches. The collected data included year, age, gender, substances involved, route of exposure, clinical effects, treatments, and medical outcome. Results A total of 94 cases discussed ECMO as a supportive option with 16 cases utilizing ECMO. Cases where ECMO was discussed rose from one case in 1997 to 13 cases in 2016. Of the 94 cases where ECMO was discussed, 38 cases (40%) involved toxicity from a cardiovascular agent(s) and 33 cases (35%) involved exposure to hydrocarbons. Of the 16 cases where ECMO was performed, 13 (81%) involved males. The median age was 17 years (range 1 month-54 years). Ten cases (63%) involve patients under the age of 18. In this series, 13 of 16 ECMO-supported patients survived (81%). Conclusions ECMO is being recommended more often for treatment of acute poisoning cases by the CPCS. All caregivers involved in the treatment of poisoning should gain a working knowledge of the potentially lifesaving technology of ECMO, its indications for use, adverse effects, and drug or poison interactions.

Usefulness of venoarterial extracorporeal membranous oxygenation for fatal cibenzoline succinate poisoning

“…Recently, ECPR has been used for the management of poisoning by other drugs, with similar effectiveness. 6,7 In this case, our patient was discharged without any neurological and cardiac complications. Because V-A ECMO makes hemodynamics stable until the blood level of drugs decreases, ECPR is recommended for the effective management of acute fatal poisoning cases involving severe cardiac dysfunction and cardiac arrest.…”

“… 3–5 Apart from this patient, two other patients with cibenzoline succinate poisoning survived after management and were discharged. Recently, ECPR has been used for the management of poisoning by other drugs, with similar effectiveness 6,7 . In this case, our patient was discharged without any neurological and cardiac complications.…”

Calcium Channel Blocker Intoxication: A Critical Care Transport Perspective

“…VA-ECMO is reserved for those patients in extremis, and although still relatively novel in the setting of poisonings, its utility has been recognized. [18][19][20][21][22] In those patients with refractory shock, the goal of VA-ECMO is to support end-organ perfusion until the cardiotoxic drug(s) can be metabolized and eliminated, and the myocardium is able to recover. [19][20][21] On account of its novelty, there are currently no clearly defined clinical indications for its use or ideal point of implementation within the context of CCB poisoning.…”

“…[19][20][21] On account of its novelty, there are currently no clearly defined clinical indications for its use or ideal point of implementation within the context of CCB poisoning. 18 However, contraindications to ECMO are well established and both relative and absolute. Relative contraindications consist of conditions with high risk for uncontrollable bleeding, advanced age, and poor prognosis.…”

Survival after extracorporeal life support (ECLS) in cardiotoxic drugs poisoning

“…Inappropriate ECMO settings lead to impaired diaphragm activity, which could consequently produce atelectasis, pulmonary complications or respiratory muscle fatigue. Although antidotes exist for a few specific situations, poisoning management is most often based on supportive treatments, particularly extracorporeal life support (ECLS) (2). Our study aimed to describe the outcome of patients treated with ECLS for cardiotropic intoxication.…”