VA ECMO and drug intoxication

Abstract

ECMO support can help in maintaining tissue perfusion and oxygenation in acutely intoxicated patients until the drug or toxin is either eliminated by the body with natural metabolism and excretory processes or possibly renal replacement therapy may be instituted to enhance the elimination. Once cardiotoxic substances reach systemic circulation and are distributed in the various tissues, the patient is present with cardiovascular dysfunction, arrhythmia, or cardiovascular collapse. Cardiovascular collapse may require temporary support of the circulatory function. This helps in hepatic detoxification over time while providing reliable tissue perfusion and allowing sufficient antidote circulation. Extracorporeal membrane oxygenation (ECMO) use in cardiotoxic drug overdose is increasing. Calcium channel blockers (CCB) along with β-blockers constitute more than 65% of deaths from cardiovascular medications whereas in the 2021, American Association of Poison Control Centers’ National Poison Data System Annual report, Tricyclic Antidepressant (TCA) accounted for 4705 single exposures and 15 deaths. VA ECMO is effective in critically ill poisoned patients who do not respond to conventional therapies and did not show any improvement along with refractory shock and acute renal failure like in CCB drug overdose and TCA-induced cardiac toxicity and cardiogenic shock, where the recovery depends mainly on maintaining perfusion. The procedure is considered as a lifesaving bridge either to recovery, to antidote, to toxin elimination with renal replacement therapy, or to transplant.