Poisoned patients treated with ECMO: 10 cases from the ToxIC Registry

May 30, 2015, 12:37 am

★★★☆☆

Extracorporeal Membrane Oxygenation (ECMO) for Severe Toxicological Exposures: Review of the Toxicology Investigators Consortium (ToxIC) Wang GS et al. J Med Toxicol 2015 May 27 [Epub ahead of print]

Abstract

The Toxicology Investigators Consortium (ToxIC) Case Registry — established in 2010 — is a database containing information from cases of known or suspected poisoning at multiple centers that were cared for at the bedside by board-certified or eligible medical toxicologists. In 2013, it comprised 38 toxicology groups and 69 separate institutions.

The authors of this study retrospectively reviewed 4-years of data (2010-2013) from the registry to identify cases treated with extracorporeal membrane oxygenation (ECMO). they identified 10 cases.Four cases involved single agents (metformin, flecainide, methanol, and cyanide. Two cases involved smoke inhalation and carbon monoxide (and perhaps cyanide as well). ECMO was initiated from 4 hours to 4 days after exposure, and was administered for a duration of 15 hours to 12 days. Four patients received cardiopulmonary resuscitation during the course of their treatment. There were 2 deaths, one in a 17-year-old female with methanol poisoning, the other in an 18-year-old man who had ingested diphenhydramine and quetiapine.

In this patient cohort, signs of severe toxicity that appeared before ECMO was started included metabolic acidosis, seizures, coma, dysrhythmias, and hypotension. In the majority of cases, ECMO was started before cardiac arrest ensued.

This is interesting data which could have been much more useful had more information been provided. For example: what were the neurological outcomes in the 8 survivors? Did they experience any complications? Were any of these patients reported previously in the literature?

For reasons I discussed in a recent column for Emergency Medicine News, ECMO has tremendous potential for treating seriously ill toxicology patient with cardiac or pulmonary failure as a “bridge to recovery” while the poison or poisons are being eliminated. I would hope that some of these cases will be written up in more detail in future publications.

Related posts:

Lipid rescue therapy and ECMO in the poisoned patient: can they be used together?

ECMO and the poisoned patient: ready for prime time?

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