A review of cardiotoxic agent poisoning and the role of VA-ECMO as reported to the National Poisons Information Service (NPIS) 2018–2023
Introduction A growing body of literature supports initiation of extracorporeal membrane oxygenation/extracorporeal life support (ECMO/ECLS) in acute severe poisoning with refractory cardiovascular collapse. VA-ECMO is occasionally initiated in the UK in patients in extremis with cardiotoxic agent p...
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| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Taylor & Francis Group
2025-12-01
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| Series: | Toxicology Communications |
| Subjects: | |
| Online Access: | https://www.tandfonline.com/doi/10.1080/24734306.2025.2524302 |
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| Summary: | Introduction A growing body of literature supports initiation of extracorporeal membrane oxygenation/extracorporeal life support (ECMO/ECLS) in acute severe poisoning with refractory cardiovascular collapse. VA-ECMO is occasionally initiated in the UK in patients in extremis with cardiotoxic agent poisoning.Methods NPIS enquiries between 01/10/2018 and 30/09/2023 involving cardiotoxic drugs and/or plants with a defined outcome (survival or death) were retrospectively reviewed.Results There were 688 cases of cardiotoxic drug or plant poisoning. These included 458 poly-agent ingestions (67%). Four hundred and eighty patients survived and 208 died. Most patients (n = 611, 89%) were adults. The role of ECMO was discussed with the NPIS in 132 (19%) cases and used in ten (2%). Among 77 paediatric patients VA-ECMO was discussed in ten (13%) and implemented in two (3%). Of the 12 (2%) patients who underwent VA-ECMO, five survived, three of whom presented to an ECMO centre. Eight of the twelve patients had taken poly-agent overdoses including propranolol (n = 4) and amlodipine (n = 3).Conclusions VA-ECMO is implemented rarely in severely poisoned patients in the UK. Questions remain about the optimal timing for initiation and the criteria for its use. Poison centres should collaborate with intensivists and ECMO specialists to explore this further. |
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| ISSN: | 2473-4306 |