Citation

Vandroux D, Aujoulat T, Gaüzère BA, Puech B, Guihard B, Martinet O. World J. Emerg. Med. 2022; 13(4): 144-150.

Copyright

(Copyright © 2022, World Journal of Emergency Medicine Press)

DOI

10.5847/WJEM.J.1920-8642.2022.070

PMID

unavailable

Abstract

BACKGROUND: Severe poisoning due to the overdosing of cardiac drugs can lead to cardiovascular failure. In order to decrease the mortality rate, the most severe patients should be transferred as quickly as possible to an extracorporeal membrane oxygenation (ECMO) center. However, the predictive factors showing the need for venous-arterial ECMO (VA-ECMO) had never been evaluated.

METHODS: A retrospective, descriptive, and single-center cohort study. All consecutive patients admitted in the largest ICU of Reunion Island (Indian Ocean) between January 2013 and September 2018 for beta-blockers (BB), calcium channel blockers (CCB), renin-angiotensin-aldosterone system blockers, digoxin or antiarrythmic intentional poisonings were included. ECMO implementation was the primary outcome.

RESULTS: A total of 49 consecutive admissions were included. Ten patients had ECMO, 39 patients did not have ECMO. Three patients in ECMO group died, while no patients in the conventional group died. The most relevant ECMO-associated factors were pulse pressure and heart rate at first medical contact and pulse pressure, heart rate, arterial lactate concentration, liver enzymes and left ventricular ejection fraction (LVEF) at ICU-admission. Only pulse pressure at first medical contact and LVEF were significant after logistic regression.

CONCLUSION: A transfer to an ECMO center should be considered for a pulse pressure < 35 mmHg at first medical contact or LVEF < 20% on admission to ICU. © 2017 World Journal of Emergency Medicine

Language: en

Keywords

adult; human; female; male; Implementation; Overdose; suicide attempt; emergency care; risk assessment; prediction; risk factor; antiarrhythmic agent; retrospective study; clinical article; drug intoxication; disease course; bleeding; noradrenalin; fatality; digoxin; beta adrenergic receptor blocking agent; heart massage; cohort analysis; calcium channel blocking agent; dobutamine; glucagon; heparin; liver enzyme; Article; aminotransferase; heart left ventricle ejection fraction; isoprenaline; pulse pressure; renin angiotensin aldosterone system; thrombus; lactic acid; Simplified Acute Physiology Score; Extracorporeal membrane oxygenation; epinephrine; Sequential Organ Failure Assessment Score; veno-arterial ECMO; Cardiac medication; Predicting factor