Extracorporeal membrane oxygenation (ECMO) may be used to provide circulatory supportin cases with poisoning.

The purpose of a new study published in Clinical Toxicology was to establish the utility of ECMO in poisoning – which can precipitate respiratory failure, shock, cardiac arrest or death.

This was a narrative review that entailed a literature search from Ovid MEDLINE spanning 1946-2020.

The study was undertaken to provide recommendations on the use of ECMO in poisonings.

The findings showed that the use of ECMO in poisoned patients is significantly increasing over time. Available data suggest that patients receiving venoarterial (VA) ECMO for refractory shock or cardiac arrest due to poisoning have lower mortality as compared to those who receive VA ECMO for non-poisoning-related indications. Poisoned patients treated with ECMO have reduced mortality as compared to those treated without ECMO; in particular, poisoned patients with refractory cardiac arrest placed on VA ECMO – termed extracorporeal cardiopulmonary resuscitation (ECPR).

Therefore, VA ECMO was suggested as an option for poisoned patients with refractory cardiogenic shock. It should be strongly considered for patients with cardiac arrest in institutions that are structured to deliver effective ECPR. Meanwhile, venovenous (VV) ECMO should be considered in poisoned patients with acute respiratory distress syndrome (ARDS) or severe respiratory failure according to traditional indications for ECMO.

Source: Clinical Toxicology (Philadelphia). 2021 Aug 16;1-11. doi:10.1080/15563650.2021.1945082.