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

Purkayastha, Sanjay; Bhangoo, Priya; Athanasiou, T; Casula, Roberto; Glenville, Brian; Darzi, Ara; Henry, John A.

doi:10.1136/emj.2005.028605

Cited by 30 publications

(15 citation statements)

References 27 publications

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“…ECLS is, however, an invasive method and may also result in life-threatening complications [ 2 ]. In a case of flecainide poisoning, ECLS was discontinued after ten hours because of persistent haemorrhage at the cannulation site [ 61 ].…”

Section: Temporary Mechanical Assistance Of the Poisoned Failing Hearmentioning

confidence: 99%

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Clinical review: Aggressive management and extracorporeal support for drug-induced cardiotoxicity

et al. 2007

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Poisoning may induce failure in multiple organs, leading to death. Supportive treatments and supplementation of failing organs are usually efficient. In contrast, the usefulness of cardiopulmonary bypass in drug-induced shock remains a matter of debate. The majority of deaths results from poisoning with membrane stabilising agents and calcium channel blockers. There is a need for more aggressive treatment in patients not responding to conventional treatments. The development of new antidotes is limited. In contrast, experimental studies support the hypothesis that cardiopulmonary bypass is life-saving. A review of the literature shows that cardiopulmonary bypass of the poisoned heart is feasible. The largest experience has resulted from the use of peripheral cardiopulmonary bypass. However, a literature review does not allow any conclusions regarding the efficiency and indications for this invasive method. Indeed, the majority of reports are single cases, with only one series of seven patients. Appealing results suggest that further studies are needed. Determination of prognostic factors predictive of refractoriness to conventional treatment for cardiotoxic poisonings is mandatory. These prognostic factors are specific for a toxicant or a class of toxicants. Knowledge of them will result in clarification of the indications for cardiopulmonary bypass in poisonings. IntroductionFailure of various organs may result in the death of acutely poisoned patients. In the 1960s, sedative-induced respiratory failure was the leading cause of death in Western countries. In these cases, endotracheal intubation and mechanical ventilation dramatically improved the prognosis. Similarly, renal replacement therapy with dialysis prevents deaths related to toxicant-induced acute renal failure. Even druginduced fulminant liver failure is successfully treated in selected cases by liver transplantation. In contrast, the usefulness of temporary mechanical assistance in druginduced cardiac failure still remains a matter of debate [1,2].However, promising results have been obtained using a combination of percutaneous cardiopulmonary support and cardiac resuscitation [3,4]. Furthermore, a recent report of the first series of acute poisonings treated with extracorporeal life support (ECLS) [5], together with an increasing number of case reports [6-10], suggests it is necessary to define the place of this aggressive treatment for drug-induced cardiotropic toxicity. Drug-induced cardiovascular shock: a leading cause of deathOver the past 30 years, improvements in the treatment of drug-induced cardiovascular shock have been due mainly to a better understanding of the different mechanisms of shock. Routine bedside haemodynamic examinations have provided evidence of the different mechanisms of drug-induced cardiovascular shock, which has enabled the selection of drugs to address the different components of shock. Within the same period of time, indications for mechanical ventilation were extended to conscious poisoned patients presenting ...

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Section: Temporary Mechanical Assistance Of the Poisoned Failing Hearmentioning

confidence: 99%

“…Even drug-induced fulminant liver failure is successfully treated in selected cases by liver transplantation. In contrast, the usefulness of temporary mechanical assistance in drug-induced cardiac failure still remains a matter of debate [ 1 , 2 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical review: Aggressive management and extracorporeal support for drug-induced cardiotoxicity

et al. 2007

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“…1 In this setting, patients with shock or persistent cardiac arrest who do not respond to optimal conventional treatment may need special therapies such as extracorporeal life support (ECLS). 2,3 In the past decade, the medical teams at the Caen University Hospital have reported their experiences using ECLS as a last resort therapeutic option in critically ill patients (i.e., with cardiac arrest or refractory shock). [4][5][6] However, despite promising results, there is currently insufficient evidence to recommend the use of ECLS as a treatment for severe cardiovascular impairment due to poisoning.…”

Section: Introductionmentioning

confidence: 99%

A comparison of survival with and without extracorporeal life support treatment for severe poisoning due to drug intoxication

et al. 2012

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“…The expected duration of cannulation is generally short, which allows avoiding the mechanical complications related to extracorporeal circuits. The survival of the patients depends on the precocity of establishment of the assistance, before the occurrence of irreversible organs failure [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Stress Cardiomyopathy Managed with Extracorporeal Support after Self-Injection of Epinephrine

Bourenne

Fresco

Kerbaul

et al. 2017

Case Reports in Critical Care

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A 28-year-old man was admitted to the ICU for self-injection of Epinephrine. This injection resulted in the rapid development of a catecholamine-induced cardiomyopathy (inverted Takotsubo) with a severe cardiogenic shock. The importance of ventricular dysfunction required the implementation of a temporary arteriovenous circulatory support until the recovery of myocardial stunning. This case allows redefining the role of circulatory assistance during cardiotropic agents intoxication.

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

Cited by 30 publications

References 27 publications

Clinical review: Aggressive management and extracorporeal support for drug-induced cardiotoxicity

Clinical review: Aggressive management and extracorporeal support for drug-induced cardiotoxicity

A comparison of survival with and without extracorporeal life support treatment for severe poisoning due to drug intoxication

Stress Cardiomyopathy Managed with Extracorporeal Support after Self-Injection of Epinephrine

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