Citation

Voicu S, M'Rad A, Malissin I, Deye N, Megarbane B. Basic Clin. Pharmacol. Toxicol. 2022; ePub(ePub): ePub.

Copyright

(Copyright © 2022, Nordic Pharmacological Society, Publisher John Wiley and Sons)

DOI

10.1111/bcpt.13804

PMID

36197954

Abstract

Extracorporeal life support (ECLS) improves circulation in life-threatening cardiac dysfunction or arrest patients. Its benefits in drug-induced cardiovascular complications are debated. Indications and outcomes are poorly established. We performed a narrative review discussing ECLS indications, timing, and results in cardiotoxicant-poisoned patients. The review was focused on antiarrhythmic drugs and aluminum phosphide. Literature analysis was limited to the past 30 years in adults. Most reports were single cases and retrospective except one prospective case series of limited size, two of them controlled. ECLS indications and timing were at the discretion of physicians in charge but mostly included persistent cardiovascular failure despite elevated doses of inotropic/vasopressor support associated with elevated blood lactate concentrations (usually, >5mmol/L) and collapsed left ventricular ejection fraction (LVEF; usually, ≤40%). Survival improved using ECLS versus standard care in one study. Survival was ~80% if ECLS was implemented in refractory cardiovascular failure and 25-66% if implemented in cardiac arrest. In two controlled studies, survival of ECLS-treated aluminum phosphide-poisoned patients was improved versus standard care, if implemented in the presence of systolic blood pressure≤80mmHg despite inotropic/vasopressor treatment, arterial pH≤7.0, and LVEF≤40%. Despite low-to-moderate level of evidence, ECLS seems effective to improve survival in selected cardiotoxicant-poisoned patients. Selection criteria need clarification.

Language: en

Keywords

Poisoning; Mortality; Aluminum phosphide; Beta-blocker; Calcium-channel blocker; Cardiotoxicant; ECMO; Extracorporeal life support; Narrative review; Sodium-channel-blocker