Summary

Peripheral circulatory support in acute poisoning: 10 years’ experience

Baud F, Lamhaut L, Jouffoy R, Carli P

Affiliation of the authors

Assistance Publique – Hôpitaux de Paris, France. Département d’anesthésie – Réanimation – SAMU de Paris. Hôpital Necker, Paris, France. Université Paris-Diderot. Paris, France. Unité UMR – Défense 8257 Cognitive Action Group, Paris, France. Université Paris Descartes, Paris, France.

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Baud F, Lamhaut L, Jouffoy R, Carli P. Peripheral circulatory support in acute poisoning: 10 years’ experience. Emergencias. 2016;28:252-62

Summary

Extracorporeal life support (ECLS) has become a common technique for treating refractory cardiogenic shock and cardiac arrest induced by drug overdose. The aim of this paper is to present our group’s 10-year experience (2002-2012)

using ECLS to treat drug-induced, refractory cardiogenic shock and cardiac arrest. We review 112 consecutive cases of acute poisoning requiring arteriovenous ECLS. We provided ECLS with a Rotaflow pump (Jostra-Maquette). In 71 cases (63%) the patient presented with refractory cardiac arrest; 41 (37%) presented with refractory cardiogenic shock. The dose ingested was very high in all cases. Survival was strongly related to presentation (cardiogenic shock vs cardiac arrest) and the type of drug taken. Survival was highest after overdoses of β-blockers and antiarrhythmic drugs and lowest

after overdoses of chloroquine, colchicine, or verapamil. Survival rates were very low in the subgroup of patients presenting with cardiac arrest who had taken hypnotics or sedatives, suggesting that the heart stopped more because of anoxia

than because of a direct cardiotoxic effect. In contrast, in cardiotoxic drug-induced cardiac arrest, the survival rate of 10% was significantly higher than the rate in non cardiotoxic arrests. Survival rates in drug-induced cardiogenic shock ranged from 45% to 100%. We conclude that ECLS should be considered for the management of cardiotoxic drug

overdose. Close cardiovascular monitoring should be initiated if a patient has taken a particularly high dose of a cardiotoxic drug. Severe cardiotoxicity is rare but life threatening. The use of ECLS in these cases should be based on clinical criteria. Early use of ECLS in drug-induced cardiogenic shock significantly improves survival. Delays in applying ECLS in severe drug-induced cardiotoxicity—diagnosed based on type of drug, dose, and hemodynamic effects—can lead to cardiac arrest and a worse outcome.