Survival after extracorporeal life support (ECLS) in cardiotoxic drugs poisoning

Abstract

<h3>Introduction</h3> Poisoning by cardiotoxic drugs is the leading cause of cardiac arrest in people under 40 years of age (1). Although antidotes exist for a few specific situations, poisoning management is most often based on supportive treatments, particularly extracorporeal life support (ECLS) (2). Our study aimed to describe the outcome of patients treated with ECLS for cardiotropic intoxication. <h3>Methods</h3> We conducted an observational, retrospective monocentric study between 2007 and 2018, in a Universitary Hospital (France). All patients implanted with ECLS for refractory cardiac arrest (RCA) or refractory cardiogenic shock (RCC) due to poisoning by cardiotoxic drugs were included. <h3>Results</h3> Among 839 ECLS performed in our hospital, 21 patients (mean age 46 ± 14 years) met the inclusion criteria. Median SAPS 2 was 80 (43-101). Five patients survived, with a good neurological outcome (CPC 1-2). Eleven patients suffered RCA with a median duration of 80 min (45-120 min), none of them survived. Ten patients have experienced refractory cardiogenic shock, 5 of them with one or more short cardiac arrest. The survivors have no cardiac arrest (3/5) or a short cardiac arrest (2/5, less than 7 min), they also have higher pH and lower blood lactate level (Table 1). The diversity of toxic and ingested doses did not allow to study their specific effect. Hemorrhagic and vascular complications related to ECLS occurred in 12 patients. <h3>Discussion</h3> ECLS after cardiotoxic drugs poisoning shows encouraging results for patients with RCC, particularly when no cardiac arrest occurs (3). It seems though reasonable to propose ECLS early during cardiogenic shock after poisoning. However, regarding RCA, the disappointing results should lead physicians to take into account other prognostic factors to guide the decision to implement ECLS, as in other RCA causes.