Justin Lewis1,2,3, M Zarate4,5, S Tran4,5, T Albertson4,5,6. 1. California Poison Control System (CPCS), Sacramento Division, 2450 48th St. ASB 1260, Sacramento, CA, 95817, USA. jlewis@calpoison.org. 2. School of Pharmacy, University of California San Francisco, San Francisco, CA, USA. jlewis@calpoison.org. 3. School of Medicine, University of California Davis, Sacramento, CA, USA. jlewis@calpoison.org. 4. California Poison Control System (CPCS), Sacramento Division, 2450 48th St. ASB 1260, Sacramento, CA, 95817, USA. 5. School of Pharmacy, University of California San Francisco, San Francisco, CA, USA. 6. School of Medicine, University of California Davis, Sacramento, CA, USA.
Abstract
INTRODUCTION: Antidotes are available to treat some specific poisonings; however, the mainstay of treatment for the poisoned patient remains supportive care. Extracorporeal membrane oxygenation (ECMO) is one of the most aggressive supportive measures available to manage poisoned patients. OBJECTIVE: To characterize the recommendation and use of ECMO in cases reported to the California Poison Control System (CPCS). METHODS: This retrospective chart review queried the CPCS database from 1997 to 2016 for cases containing the American Association of Poison Control Centers (AAPCC) code for ECMO, and "ECMO" and "ECLS" free-text searches. The collected data included year, age, gender, substances involved, route of exposure, clinical effects, treatments, and medical outcome. RESULTS: A total of 94 cases discussed ECMO as a supportive option with 16 cases utilizing ECMO. Cases where ECMO was discussed rose from one case in 1997 to 13 cases in 2016. Of the 94 cases where ECMO was discussed, 38 cases (40%) involved toxicity from a cardiovascular agent(s) and 33 cases (35%) involved exposure to hydrocarbons. Of the 16 cases where ECMO was performed, 13 (81%) involved males. The median age was 17 years (range 1 month-54 years). Ten cases (63%) involve patients under the age of 18. In this series, 13 of 16 ECMO-supported patients survived (81%). CONCLUSIONS: ECMO is being recommended more often for treatment of acute poisoning cases by the CPCS. All caregivers involved in the treatment of poisoning should gain a working knowledge of the potentially lifesaving technology of ECMO, its indications for use, adverse effects, and drug or poison interactions.
INTRODUCTION: Antidotes are available to treat some specific poisonings; however, the mainstay of treatment for the poisoned patient remains supportive care. Extracorporeal membrane oxygenation (ECMO) is one of the most aggressive supportive measures available to manage poisoned patients. OBJECTIVE: To characterize the recommendation and use of ECMO in cases reported to the California Poison Control System (CPCS). METHODS: This retrospective chart review queried the CPCS database from 1997 to 2016 for cases containing the American Association of Poison Control Centers (AAPCC) code for ECMO, and "ECMO" and "ECLS" free-text searches. The collected data included year, age, gender, substances involved, route of exposure, clinical effects, treatments, and medical outcome. RESULTS: A total of 94 cases discussed ECMO as a supportive option with 16 cases utilizing ECMO. Cases where ECMO was discussed rose from one case in 1997 to 13 cases in 2016. Of the 94 cases where ECMO was discussed, 38 cases (40%) involved toxicity from a cardiovascular agent(s) and 33 cases (35%) involved exposure to hydrocarbons. Of the 16 cases where ECMO was performed, 13 (81%) involved males. The median age was 17 years (range 1 month-54 years). Ten cases (63%) involve patients under the age of 18. In this series, 13 of 16 ECMO-supported patients survived (81%). CONCLUSIONS: ECMO is being recommended more often for treatment of acute poisoning cases by the CPCS. All caregivers involved in the treatment of poisoning should gain a working knowledge of the potentially lifesaving technology of ECMO, its indications for use, adverse effects, and drug or poison interactions.
Authors: William A Watson; Toby L Litovitz; George C Rodgers; Wendy Klein-Schwartz; Nicole Reid; Jessica Youniss; Anne Flanagan; Kathleen M Wruk Journal: Am J Emerg Med Date: 2005-09 Impact factor: 2.469
Authors: M Holzer; F Sterz; W Schoerkhuber; W Behringer; H Domanovits; D Weinmar; C Weinstabl; T Stimpfl Journal: Crit Care Med Date: 1999-12 Impact factor: 7.598