ECMO for Poisoned Patients

Today’s pearl is about treating patient in refractory toxin-induced cardiogenic shock with venoarterial-extracorporeal membrane oxygenation (VA-ECMO).

Is ECMO an effective treatment?

If we can support patients in toxin-induced cardiogenic shock until the drug is metabolized and the risk of toxicity has passed, then VA-ECMO should offer an additional treatment option during the severe shock period. Earlier studies reported survival rates as high as 80% in this patient population (Wang 2016, de Lange 2013).

The largest cohort to date was recently published and evaluated 104 cases from the Extracorporeal Life Support Organization (ELSO)’s ECMO case registry (Weiner 2019).

  • 53% survived
  • Cardiovascular toxins were the most frequent cause (47%), followed by opioids (7%)
  • Median duration of VA-ECMO was 68 hrs
  • ECMO significantly improved hemodynamics (MAP, SBP, and DBP), acidemia/acidosis (pH, HCO3 level), and ventilatory parameters (pO2, SpO2, and SvO2)
  • Renal replacement therapy (50.9%) and dysrhythmia (26.3%) were the most frequently reported complications

Take-home point:

If you have a patient with toxin-induced cardiogenic shock, consider involving our ECMO team early for evaluation

#28

Author: Bryan D. Hayes, PharmD

Attending Pharmacist, Emergency Medicine and Toxicology, Massachusetts General Hospital; Assistant Professor of EM, Harvard Medical School

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