Venoarterial Extracorporeal Membrane Oxygenation in Severe Drug Intoxication: A Retrospective Comparison of Survivors and Nonsurvivors.
Journal
ASAIO journal (American Society for Artificial Internal Organs : 1992)
ISSN: 1538-943X
Titre abrégé: ASAIO J
Pays: United States
ID NLM: 9204109
Informations de publication
Date de publication:
01 07 2022
01 07 2022
Historique:
pubmed:
25
9
2021
medline:
1
7
2022
entrez:
24
9
2021
Statut:
ppublish
Résumé
Selecting patients most likely to benefit from venoarterial extracorporeal membrane oxygenation (V-A ECMO) to treat refractory drug-induced cardiovascular shock remains a difficult challenge for physicians. This study reported short-term survival outcomes and factors associated with mortality in V-A ECMO-treated patients for poisoning. Twenty-two patients placed on V-A ECMO after drug intoxication from January 2014 to December 2020 were retrospectively analyzed. The primary endpoint of this study was survival at hospital discharge. Univariate descriptive analysis was performed to compare survivors and nonsurvivors during hospitalization. The overall survival at hospital discharge was 45.4% (n = 10/22). Survival rate tended to be higher in patients treated for refractory shock (n = 7/10) compared with those treated for refractory cardiac arrest (n = 3/12, p = 0.08). Low-flow duration and time from admission to ECMO cannulation were shorter in survivors ( p = 0.02 and p = 0.03, respectively). Baseline characteristics before ECMO, including the class of drugs involved in the poisoning, between survivors and nonsurvivors were not statistically different except pH, bicarbonate, serum lactate, Sequential Organ Failure Assessment, and Survival After Veno-arterial-ECMO (SAVE) score. All patients with SAVE-score risk classes II/III survived whereas 85.7% (n = 12/14) of those with SAVE-score risk classes IV/V died. A lactic acid >9 mmol/L predicts mortality with a sensitivity/specificity ratio of 83.3%/100%. V-A ECMO for severe drug intoxication should be reserved for highly selected poisoned patients who do not respond to conventional therapies. Shortening the timing of V-A ECMO initiation should be a key priority in improving outcomes. Low-flow time >60min, lactic acid >9mmol/L, and SAVE-score may be good indicators of a worse prognosis.
Identifiants
pubmed: 34560717
doi: 10.1097/MAT.0000000000001583
pii: 00002480-202207000-00005
doi:
Substances chimiques
Lactic Acid
33X04XA5AT
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
907-913Informations de copyright
Copyright © ASAIO 2021.
Déclaration de conflit d'intérêts
V-A ECMO IN SEVERE DRUG INTOXICATIONDisclosure: The authors have no conflicts of interest to report.
Références
Gummin DD, Mowry JB, Beuhler MC, et al.: 2019 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 37th Annual Report. Clin Toxicol Phila Pa. 58: 1360–1541, 2020.
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. 48: 1111–1119, 2020.
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 Pa. 58: 705–710, 2020.
Combes A, Brodie D, Chen Y-S, et al.: The ICM research agenda on extracorporeal life support. Intensive Care Med. 43: 1306–1318, 2017.
Mégarbane B, Leprince P, Deye N, et al.: Emergency feasibility in medical intensive care unit of extracorporeal life support for refractory cardiac arrest. Intensive Care Med. 33: 758–764, 2007.
Daubin C, Lehoux P, Ivascau C, et al.: Extracorporeal life support in severe drug intoxication: A retrospective cohort study of seventeen cases. Crit Care. 13: R138, 2009.
de Lange DW, Sikma MA, Meulenbelt J: Extracorporeal membrane oxygenation in the treatment of poisoned patients. Clin Toxicol Phila Pa. 51: 385–393, 2013.
Chenoweth JA, Colby DK, Sutter ME, et al.: Massive diltiazem and metoprolol overdose rescued with extracorporeal life support. Am J Emerg Med. 35: 1581.e3–1581.e5, 2017.
Belin N, Clair al, Chocron S, Capellier G, Piton G: Refractory cardiogenic shock during tramadol poisoning: A case report. Cardiovasc Toxicol. 17: 219–222, 2017.
Maskell KF, Ferguson NM, Bain J, Wills BK: Survival after cardiac arrest: ECMO rescue therapy after amlodipine and metoprolol overdose. Cardiovasc Toxicol. 17: 223–225, 2017.
Cheng R, Hachamovitch R, Kittleson M, et al.: Complications of extracorporeal membrane oxygenation for treatment of cardiogenic shock and cardiac arrest: A meta-analysis of 1,866 adult patients. Ann Thorac Surg. 97: 610–616, 2014.
Pozzi M, Koffel C, Djaref C, et al.: High rate of arterial complications in patients supported with extracorporeal life support for drug intoxication-induced refractory cardiogenic shock or cardiac arrest J Thorac Dis. 9: 1988–1996, 2017.
Ponikowski P, Voors AA, Anker SD, et al.; ESC Scientific Document Group: 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 37: 2129–2200, 2016.
Baud FJ, Megarbane B, Deye N, Leprince P: Clinical review: Aggressive management and extracorporeal support for drug-induced cardiotoxicity. Crit Care. 11: 207, 2007.
Dangers L, Bréchot N, Schmidt M, et al.: Extracorporeal membrane oxygenation for acute decompensated heart failure. Crit Care Med. 45: 1359–1366, 2017.
Conseil français de réanimation cardiopulmonaire, Société française d’anesthésie et de réanimation, Société française de cardiologie, : Guidelines for indications for the use of extracorporeal life support in refractory cardiac arrest. French Ministry of Health Ann Fr Anesth Reanim. 28: 182–190, 2009.
Aissaoui N, Luyt CE, Leprince P, et al.: Predictors of successful extracorporeal membrane oxygenation (ECMO) weaning after assistance for refractory cardiogenic shock. Intensive Care Med. 37: 1738–1745, 2011.
Vincent JL, de Mendonça A, Cantraine F, et al.: Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: Results of a multicenter, prospective study. Working group on “sepsis-related problems” of the European Society of Intensive Care Medicine. Crit Care Med. 26: 1793–1800, 1998.
Schmidt M, Burrell A, Roberts L, et al.: Predicting survival after ECMO for refractory cardiogenic shock: The Survival After Veno-arterial-ECMO (SAVE)-score. Eur Heart J. 36: 2246–2256, 2015.
Wang GS, Levitan R, Wiegand TJ, Lowry J, Schult RF, Yin S; Toxicology Investigators Consortium: Extracorporeal Membrane Oxygenation (ECMO) for Severe Toxicological Exposures: Review of the Toxicology Investigators Consortium (ToxIC). J Med Toxicol. 12: 95–99, 2016.
Masson R, Colas V, Parienti JJ, et al.: A comparison of survival with and without extracorporeal life support treatment for severe poisoning due to drug intoxication. Resuscitation. 83: 1413–1417, 2012.
Baud F, Lamhaut L, Jouffoy R, Carli P: Peripheral circulatory support in acute poisoning: 10 years’ experience. Emerg Rev Soc Espanola Med Emerg. 28: 252–262, 2016.
Lewis J, Zarate M, Tran S, Albertson T: The recommendation and use of Extracorporeal Membrane Oxygenation (ECMO) in cases reported to the California Poison Control System. J Med Toxicol. 15: 169–177, 2019.
Ramanathan K, Tan CS, Rycus P, MacLaren G: Extracorporeal membrane oxygenation for poisoning in adult patients: Outcomes and predictors of mortality. Intensive Care Med. 43: 1538–1539, 2017.
St-Onge M, Anseeuw K, Cantrell FL, et al.: Experts Consensus Recommendations for the Management of Calcium Channel Blocker Poisoning in Adults. Crit Care Med. 45: e306–e315, 2017.
St-Onge M, Fan E, Mégarbane B, Hancock-Howard R, Coyte PC: Venoarterial extracorporeal membrane oxygenation for patients in shock or cardiac arrest secondary to cardiotoxicant poisoning: A cost-effectiveness analysis. J Crit Care. 30: 437.e7–437.14, 2015.
Vaillancourt C, Everson-Stewart S, Christenson J, et al.; Resuscitation Outcomes Consortium Investigators: The impact of increased chest compression fraction on return of spontaneous circulation for out-of-hospital cardiac arrest patients not in ventricular fibrillation. Resuscitation. 82: 1501–1507, 2011.
Shin TG, Choi JH, Jo IJ, et al.: Extracorporeal cardiopulmonary resuscitation in patients with inhospital cardiac arrest: A comparison with conventional cardiopulmonary resuscitation. Crit Care Med. 39: 1–7, 2011.
Sakamoto T, Morimura N, Nagao K, et al.; SAVE-J Study Group: Extracorporeal cardiopulmonary resuscitation versus conventional cardiopulmonary resuscitation in adults with out-of-hospital cardiac arrest: A prospective observational study. Resuscitation. 85: 762–768, 2014.
Wengenmayer T, Rombach S, Ramshorn F, et al.: Influence of low-flow time on survival after extracorporeal cardiopulmonary resuscitation (eCPR). Crit Care. 21: 157, 2017.
Richardson ASC, Tonna JE, Nanjayya V, et al.: Extracorporeal cardiopulmonary resuscitation in adults. Interim Guideline Consensus Statement From the Extracorporeal Life Support Organization. ASAIO J. 67: 221–228, 2021.
Combes A, Leprince P, Luyt CE, et al.: Outcomes and long-term quality-of-life of patients supported by extracorporeal membrane oxygenation for refractory cardiogenic shock. Crit Care Med. 36: 1404–1411, 2008.
Bismuth C, Baud F, Dally S: Standardized prognosis evaluation in acute toxicology its benefit in colchicine, paraquat and digitalis poisonings. J Toxicol Clin Exp. 6: 33–38, 1986.
Brunet J, Valette X, Ivascau C, et al.: Extracorporeal life support for refractory cardiac arrest or shock: A 10-year study ASAIO J Am Soc Artif Intern Organs 1992. 61: 676–681, 2015.