CC-BY-NC-ND 4.0 · J Card Crit Care 2017; 1(02): 82-88
DOI: 10.1055/s-0038-1626679
Review Article
Thieme Medical and Scientific Publishers Private Ltd. 2017

ECMO in Poisoning

Vivek Gupta
1  Department of Cardiac Anaesthesia and Intensive care, Hero DMC Heart Institute, Ludhiana, Punjab, India
,
Gurpreet S. Wander
2  Department of Cardiology, Hero DMC Heart Institute, Ludhiana, Punjab, India
› Author Affiliations

Subject Editor:
Further Information

Publication History

Publication Date:
07 March 2018 (online)

Abstract

Severe poisoning may lead to life-threatening situation or death due to cardiovascular dysfunction, arrhythmia, or cardiogenic shock. The poisoning substance varies in different parts of world; in the Western world, the drugs with cardiotoxic potential are more common, while pesticides and other household toxins are common in the rest of the world. However, most of these patients are relatively young and otherwise healthy irrespective of poisoning substances. Extracorporeal membrane oxygenation (ECMO) has regained interest in recent past and now its use is being explored for newer indications. The use of ECMO in poisoning has shown promising results as salvage therapy and can be used as bridge to recovery, antidote, and toxin removal with renal replacement therapy or transplant. The ECMO has been used in those poisoned patients who have persistent cardiogenic shock or refractory hypoxemia despite adequate supportive therapy. ECMO may be useful in providing adequate cardiac output and maintain tissue perfusion which helps in the redistribution of toxins from central circulation and facilitate the metabolism and excretion. However, the available literature is not sufficient and is based on case reports, case series, and retrospective cohort study. In spite of high mortality with severe poisoning and encouraging outcome with use of ECMO, it is an underutilized modality across the world. Though evidences suggest that early consideration of ECMO in severely poisoned patients with refractory cardiac arrest or hemodynamic compromise refractory to standard therapies may be beneficial, the right time to start ECMO in poisoned patients, criteria to start ECMO, and prognostication prior to initiation of ECMO is yet to be answered. Future studies and publications may address these issues, whereas the ELSO (Extracorporeal Life Support Organization) data registry may help in collecting global data on poisoning more effectively.