TY  - JOUR
PY  - 2022//
TI  - Extracorporeal life support in cardiotoxicant poisoning - a narrative review
JO  - Basic and Clinical Pharmacology and Toxicology
A1  - Megarbane, Bruno
A1  - Deye, Nicolas
A1  - Malissin, Isabelle
A1  - M'Rad, Aymen
A1  - Voicu, Sebastian
SP  - ePub
EP  - ePub
VL  - ePub
IS  - ePub
N2  - Extracorporeal life support (ECLS) improves circulation in life-threatening cardiac dysfunction or arrest patients. Its benefits in drug-induced cardiovascular complications are debated. Indications and outcomes are poorly established. We performed a narrative review discussing ECLS indications, timing, and results in cardiotoxicant-poisoned patients. The review was focused on antiarrhythmic drugs and aluminum phosphide. Literature analysis was limited to the past 30 years in adults. Most reports were single cases and retrospective except one prospective case series of limited size, two of them controlled. ECLS indications and timing were at the discretion of physicians in charge but mostly included persistent cardiovascular failure despite elevated doses of inotropic/vasopressor support associated with elevated blood lactate concentrations (usually, >5mmol/L) and collapsed left ventricular ejection fraction (LVEF; usually, ≤40%). Survival improved using ECLS versus standard care in one study. Survival was ~80% if ECLS was implemented in refractory cardiovascular failure and 25-66% if implemented in cardiac arrest. In two controlled studies, survival of ECLS-treated aluminum phosphide-poisoned patients was improved versus standard care, if implemented in the presence of systolic blood pressure≤80mmHg despite inotropic/vasopressor treatment, arterial pH≤7.0, and LVEF≤40%. Despite low-to-moderate level of evidence, ECLS seems effective to improve survival in selected cardiotoxicant-poisoned patients. Selection criteria need clarification.<p />  <p>Language: en</p>
LA  - en
SN  - 1742-7835
UR  - http://dx.doi.org/10.1111/bcpt.13804
ID  - ref1
ER  -