Extracorporeal Membrane Oxygenation in Intoxication and Overdoses: A Systematic Review

Abstract

Extracorporeal membrane oxygenation (ECMO) has been increasingly applied over recent decades to treat severe cardiogenic shock and acute lung failure and cardiac arrest of various causes. Acute intoxication with therapeutic substances or other chemical substances can cause severe cardiogenic shock or even cardiac arrest. The purpose of this study was to conduct a qualitative systematic review of ECMO use in intoxication and poisoning. We searched the PubMed, Medline, and Web of Science databases from January 1971 to December 2021 and selected appropriate studies according to our inclusion and exclusion criteria to evaluate the role of ECMO in intoxication and poisoning systematically. Survival at hospital discharge was examined to describe the outcome. The search resulted in 365 publications after removing duplicates. In total, 190 full-text articles were assessed for eligibility. A total of 145 articles from 1985 to 2021 were examined in our final qualitative analysis. A total of 539 (100%) patients were included (mean age: 30.9 ± 16.6 years), with a distribution of n = 64 (11.9%) cases with venovenous (vv) ECMO, n = 218 (40.4%) cases with venoarterial (va) ECMO, and n = 257 (47.7%) cases with cardiac arrest and extracorporeal cardiopulmonary resuscitation. Survival at hospital discharge was 61.0% for all patients, 68.8% for vaECMO, 75% for vvECMO, and 50.9% for extracorporeal cardiopulmonary resuscitation. When used and reported, ECMO seems to be a valid tool for adult and pediatric patients suffering intoxication from various pharmaceutical and nonpharmaceutical substances due to a high survival rate at hospital discharge.

Keywords

extracorporeal membrane oxygenation - intensive care - intoxications - shock (systemic - cardiac - or circulatory)

Authors' Contribution

S.M., L.R., and L.S. were responsible for the conception and design of the work; S.M., L.S., L.R., and J.S. were responsible for literature search; S.M., L.S., L.R., and J.S. were responsible for data collection; M.C., F.B., and C.B. were reposnible for data analysis and interpretation; M. C., F.B., and C.B. were responsible for statistical analysis; S.M., M.C., and C.B. were responsible for drafting the manuscript; M.C., F.B., and C.B. were responsible for critical revision the work.

Publikationsverlauf

Eingereicht: 12. August 2022

Angenommen: 23. Januar 2023

Artikel online veröffentlicht:
20. März 2023

• References

• 1 Gummin DD, Mowry JB, Beuhler MC. et al. 2020 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 38th Annual Report. Clin Toxicol (Phila) 2021; 59 (12) 1282-1501
• 2 Federal Statistical Office. . Federal Republic of Germany. Accessed February 14, 2022 at: https://www.destatis.de
• 3 Extracorporeal Life Support Organizaion. . ECLS Registry Report. 2021. Accessed February 13 at: https://www.elso.org/Registry/Statistics/InternationalSummary.aspx
• 4 Duerschmied D, Zotzmann V, Rieder M. et al. Myocardial infarction type 1 is frequent in refractory out-of-hospital cardiac arrest (OHCA) treated with extracorporeal cardiopulmonary resuscitation (ECPR). Sci Rep 2020; 10 (01) 8423
• 5 Cole JB, Olives TD, Ulici A. et al. Extracorporeal membrane oxygenation for poisonings reported to U.S. Poison Centers from 2000 to 2018: an analysis of the national poison data system. Crit Care Med 2020; 48 (08) 1111-1119
• 6 Weiner L, Mazzeffi MA, Hines EQ, Gordon D, Herr DL, Kim HK. Clinical utility of venoarterial-extracorporeal membrane oxygenation (VA-ECMO) in patients with drug-induced cardiogenic shock: a retrospective study of the Extracorporeal Life Support Organizations' ECMO case registry. Clin Toxicol (Phila) 2020; 58 (07) 705-710
• 7 Page MJ, McKenzie JE, Bossuyt PM. et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021; 372 (71) n71
• 8 Sin JH, Tom A, Toyoda A, Roy N, Hayes BD. High-dose intravenous lipid emulsion affecting successful initiation of continuous venovenous hemofiltration and extracorporeal membrane oxygenation. Clin Toxicol (Phila) 2018; 56 (02) 149-150
• 9 Gulkarov I, Khusid E, Worku B. et al. Meta-analysis of the effect of vascular complications on mortality in patients undergoing femoral venoarterial extracorporeal membrane oxygenation. Ann Vasc Surg 2021; 71: 488-495
• 10 Mou Z, Guan T, Chen L. Risk factors of acute kidney injury in ECMO patients: a systematic review and meta-analysis. J Intensive Care Med 2022; 37 (02) 267-277
• 11 Nguyen TP, Phan XT, Nguyen TH. et al. Major Bleeding in Adults Undergoing Peripheral Extracorporeal Membrane Oxygenation (ECMO): Prognosis and Predictors. Crit Care Res Pract 2022; 2022: 5348835
• 12 Nunez JI, Gosling AF, O'Gara B. et al. Bleeding and thrombotic events in adults supported with venovenous extracorporeal membrane oxygenation: an ELSO registry analysis. Intensive Care Med 2022; 48 (02) 213-224
• 13 Xie A, Lo P, Yan TD, Forrest P. Neurologic complications of extracorporeal membrane oxygenation: a review. J Cardiothorac Vasc Anesth 2017; 31 (05) 1836-1846
• 14 Brunet J, Valette X, Ivascau C. et al. Extracorporeal life support for refractory cardiac arrest or shock: a 10-year study. ASAIO J 2015; 61 (06) 676-681
• 15 Masson R, Colas V, Parienti J-J. et al. A comparison of survival with and without extracorporeal life support treatment for severe poisoning due to drug intoxication. Resuscitation 2012; 83 (11) 1413-1417
• 16 Lunz D, Calabrò L, Belliato M. et al. Extracorporeal membrane oxygenation for refractory cardiac arrest: a retrospective multicenter study. Intensive Care Med 2020; 46 (05) 973-982
• 17 Napp LC, Ziegeler S, Kindgen-Milles D. Rationale of hemoadsorption during extracorporeal membrane oxygenation support. Blood Purif 2019; 48 (03) 203-214
• 18 Schroeder I, Zoller M, Angstwurm M, Kur F, Frey L. Venlafaxine intoxication with development of takotsubo cardiomyopathy: successful use of extracorporeal life support, intravenous lipid emulsion and CytoSorb®. Int J Artif Organs 2017; 40 (07) 358-360
• 19 Li Y, Qiu Z, Huang L, Cao C. Extracorporeal membrane oxygenation combined with sequential blood purification in the treatment of myocardial damage and cardiac arrest caused by mushroom poisoning. Toxicon 2021; 197: 65-69
• 20 Taccone FS, Gardette M, Creteur J, Brasseur A, Lorent S, Grimaldi D. Hemoadsorption to treat severe iatrogenic intoxication with Patent Blue: a case report. J Med Case Reports 2021; 15 (01) 63
• 21 Zickler D, Nee J, Arnold T. et al. Use of hemoadsorption in patients with severe intoxication requiring extracorporeal cardiopulmonary support—a case series. ASAIO J 2021; 67 (11) e186-e190
• 22 Badulak JH, Curtis E, Bulger EM. ECMO membrane lung failure due to hypertriglyceridemia: a case report and review of the literature. J Extra Corpor Technol 2020; 52 (03) 237-241
• 23 Albrecht E, Baeriswyl M, Orrit J, Kirkham KR. Lipid emulsion layering in extracorporeal membrane oxygenation circuit. Intensive Care Med 2016; 42 (11) 1806-1807
• 24 Lee HMD, Archer JRH, Dargan PI, Wood DM. What are the adverse effects associated with the combined use of intravenous lipid emulsion and extracorporeal membrane oxygenation in the poisoned patient?. Clin Toxicol (Phila) 2015; 53 (03) 145-150
• 25 Iolascon A, Bianchi P, Andolfo I. et al; SWG of red cell and iron of EHA and EuroBloodNet. Recommendations for diagnosis and treatment of methemoglobinemia. Am J Hematol 2021; 96 (12) 1666-1678
• 26 Morrison A, Polisena J, Husereau D. et al. The effect of English-language restriction on systematic review-based meta-analyses: a systematic review of empirical studies. Int J Technol Assess Health Care 2012; 28 (02) 138-144