ECMO and the poisoned patient: ready for prime time?
August 30, 2013, 1:44 pm
Extracorporeal membrane oxygenation in the treatment of poisoned patients. De Lange DW et al. Clin Toxicol 2013 Jun;51:385-393.
The authors note that although extracorporeal membrane oxygenation (ECMO) had somewhat fallen out of favor, especially for treatment of adult patients, continued improvements in technology have prompted reconsideration of the modality. This renewed interest was also spurred by the low reported mortality among patients with severe acute respiratory distress syndrome (ARDS) treated with ECMO during the 2009 A/H1N1 flu pandemic.(A recent review points out, however, that similar influenza cases treated without ECMO had comparable favorable clinical outcomes.)
To evaluate the potential role of ECMO in treating poisoned patients, the authors conducted a literature review, identifying 46 publications consisting of case reports or case series of patients treated with ECMO for various intoxications. They did not find any randomized studies.
There are basically two types of ECMO:
- Veno-venous: potentially useful as a bridge to provide oxygenation and carbon dioxide removal while damage to the respiratory tract heals from irritant or alveolar injury
- Veno-arterial: potentially provides oxygenation and CO2 removal as well as cardiovascular support in circulatory shock
There are no good studies evaluating ECMO vs. standard care in poisoned patients, and most likely there never will be. ECMO is not widely available, so most clinicians will not have to decide on whether or when to initiate it. However, for those interested in a general description of the technology and its potential use in toxicology cases, this paper makes interesting reading.