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Observational Study
. 2022 Jun;37(6):1512-1519.
doi: 10.1111/jocs.16456. Epub 2022 Mar 30.

Veno-arterial extracorporeal membrane oxygenation for drug intoxications: A single center, 14-year experience

Matteo Pozzi  1   2 , Rémi Buzzi  1 , Ahmad Hayek  3 , Philippe Portran  4 , Rémi Schweizer  4 , Jean Luc Fellahi  4 , Xavier Armoiry  5 , Michele Flagiello  1 , Daniel Grinberg  1 , Jean Francois Obadia  1
Affiliations
Observational Study

Veno-arterial extracorporeal membrane oxygenation for drug intoxications: A single center, 14-year experience

Matteo Pozzi et al. J Card Surg. 2022 Jun.

Abstract

Background and aim of the study: Acute cardiovascular failure remains a leading cause of death in severe poisonings. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has been increasingly used as a rescue therapeutic option for those cases refractory to optimal conventional treatment. We sought to evaluate the outcomes after VA-ECMO used for drug intoxications in a single-center experience.

Methods: We performed an observational analysis of our prospective institutional database. The primary endpoint was survival to hospital discharge.

Results: Between January 2007 and December 2020, 32 patients (mean age: 45.4 ± 15.8 years; 62.5% female) received VA-ECMO for drug intoxication-induced refractory cardiogenic shock (n = 25) or cardiac arrest (n = 7). Seven (21.8%) patients developed lower limb ischemia during VA-ECMO support. Twenty-six (81.2%) patients were successfully weaned after a mean VA-ECMO support of 2.9 ± 1.3 days. One (3.1%) patient died after VA-ECMO weaning for multiorgan failure and survival to hospital discharge was 78.1% (n = 25). In-hospital survivors were discharged from hospital with a good neurological status. Survival to hospital discharge was not statistically different according to sex (male = 75.0% vs. female = 80.0%; p = .535), type of intoxication (single drug = 81.8% vs. multiple drugs = 76.1%; p = .544) and location of VA-ECMO implantation (within our center = 75% vs. peripheral hospital using our Mobile Unit of Mechanical Circulatory Support = 100%; p = .352). Survival to hospital discharge was significantly lower in patients receiving VA-ECMO during on-going cardiopulmonary resuscitation (42.8% vs. 88.0%; p = .026).

Conclusions: VA-ECMO appears to be a feasible therapeutic option with a satisfactory survival rate and acceptable complications rate in poisonings complicated by refractory cardiogenic shock or cardiac arrest.

Keywords: cardiac arrest; cardiogenic shock; extracorporeal membrane oxygenation; poisoning.

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References

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