UMEM Educational Pearls

Title: Clinical utility of VA-ECMO in refractory drug-induced cariogenic shock

Keywords: VA-ECMO, drug-induced cardiogenic shock (PubMed Search)

Posted: 10/24/2019 by Hong Kim, MD, MPH
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Patients with drug-induced cardiogenic shock [DIC] (e.g. overdose of CCB/BB, membrane stabilizing agents, etc.) are often managed with medical interventions such as vasopressors, bicarbonate infusion, high-dose insulin, lipid emulsion therapy. A fraction of these patients may be refractory to the standard medical therapy. VA-ECMO (venoarterial extracorporeal membrane oxygenation) has been utilized in such situation; yet clinical experience of using VA-ECMO in DIC is limited.

A recent retrospective study of the Extracorporeal Life Support Organization’s ECMO registry showed

Increasing VA-ECMO utilization for drug-induced cardiogenic shock (n=104) over the past 15 years (2003 to 2018) but it represents a fraction (0.067%) of VA-ECMO use.
VA-ECMO improved hemodynamic and metabolic status at 24 hrs-post cannulation.
Persistent acidosis (HCO3 level) and acidemia (pH) at 24 hrs-post cannulation was associated with mortality.
52.9% of the cases survived to discharge.

Conclusion

VA-ECMO may be clinically beneficial (improvement of hemodynamic and metaboic status) in patients with refractory drug-induce cardiogenic shock

References

Weiner L1, Mazzeffi MA2, Hines EQ3, Gordon D4, Herr DL5, Kim HK6.

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

2019 Oct 16:1-6. doi: 10.1080/15563650.2019.1676896. [Epub ahead of print]