UMEM Educational Pearls

Title: ECMO for Severely Poisoned Patients

Keywords: Extracorporeal Membrane Oxygenation, ECMO, toxicology, poison (PubMed Search)

Posted: 4/13/2016 by Bryan Hayes, PharmD (Updated: 4/14/2016)
Click here to contact Bryan Hayes, PharmD

The American College of Medical Toxicology's ToxIC Registry is a self-reporting database completed by medical toxicologists across 69 insitutions in the US.

Over a 3 year period, just 10 cases in the database received ECMO: 4 pediatric, 2 adolescent, and 4 adults (individual cases presented in the table below)
Time of initiation of ECMO ranged from 4 h to 4 days, with duration from 15 h to 12 days
Exposures included carbon monoxide/smoke inhalation (2), bitter almonds, methanol, and several medications including antihistamines (2), antipsychotic/antidepressant (2), cardiovascular drugs (2), analgesics (2), sedative/hypnotics (2), and antidiabetics (2)
Overall survival rate was 80%

Application to Clinical Practice

In settings where ECMO is available, it may be a potential treatment option in severely poisoned patients. From the limited data, ECMO was generally administered prior to cardiovascular failure and might be of benefit particularly during the time the drug is being metabolized.

Table from the Case Series

References

Wang GS, et al. Extracorporeal Membrane Oxygenation (ECMO) for Severe Toxicological Exposures: Review of the Toxicology Investigators Consortium (ToxIC). J Med Toxicol 2016;12(1):95-9. [PMID 26013746]

Follow me on Twitter (@PharmERToxGuy)