UMEM Educational Pearls

Category: Toxicology

Title: Trend of ECMO use for poisoning in the US: 2000 to 2018

Keywords: ECMO, poisoning, trend in US (PubMed Search)

Posted: 9/10/2020 by Hong Kim, MD, MPH (Updated: 10/21/2020)
Click here to contact Hong Kim, MD, MPH

 

Extracorporeal membrane oxygenation use is increasing in the US for acute poisoning. 

A retrospective study of the National Poison Data System from 2000 to 2018 identified 407 ECMO cases (332 adults – age > 12 years, 75 pediatric – age < 12 years). Increase in ECMO use were more notable in adult population.

 

Characteristics

  • Median age: 27 years (IQR: 15-39)
  • Male: 52.6%
  • Single substance exposure: 51.5%
  • Median number of exposures: 3 (IQR: 2-4)
  • Overall survival: 70%

Intentional exposure

  • Age > 12 years: 72.6%
  • Age < 12 years: 9.3%

Most common class of drug/poison exposure in adults

  • Sedative/hypnotic: 26%
  • Antidepressants: 25%
  • Calcium channel blockers: 19%
  • Opioids: 17%

Most common class of drug/poison exposure in children

  • Hydrocarbons: 37%
  • Antiarrhythmics: 15%
  • Antihistamine: 8%
  • Unknown: 8%

Most common states that used ECMO for poisoning

  • Pennsylvania: 45
  • Texas: 27
  • Minnesota: 24
  • Maryland: 22
  • Michigan: 20
  • New York: 20

 

Conclusion

  • Increase in EMCO use was most notable in patients with age > 12 years
  • There was no significant trend in mortality during the study period
  • ECMO cases were mostly reported from urban areas