title: Extracorporeal life support in severe drug intoxication: a retrospective cohort study of seventeen cases.
abstract: BACKGROUND
  Cardiovascular failure is the leading cause of death in severe acute drug intoxication. In this setting, we report the feasibility, complications, and outcome of emergency extracorporeal life support (ECLS) in refractory shock or cardiac arrest following a drug overdose.
  
  
  METHODS
  This is a retrospective cohort study of 17 patients admitted over a 10-year period for prolonged cardiac arrest or refractory shock following a drug overdose and not responding to optimal conventional treatment. Patients were evaluated in the medical ICU and cardiovascular surgery department of a university hospital. ECLS implantation used a centrifugal pump connected to a hollow-fiber membrane oxygenator and was performed in the operating room (n = 13), intensive care unit (n = 3), or emergency department (n = 1). ECLS was employed for refractory shock and prolonged cardiac arrest in 10 and 7 cases, respectively.
  
  
  RESULTS
  The mean duration of external cardiac massage was 101 +/- 55 minutes. Fifteen patients had ingested cardiotoxic drugs, including 11 cases of drugs with membrane stabilizing activity. Time from hospital admission to initiation of ECLS was 6.4 +/- 7.0 hours. Time to ECLS implant was 58 +/- 11 minutes. The mean ECLS flow rate was 3.45 +/- 0.45 L/min. The average ECLS duration was 4.5 +/- 2.4 days. Early complications included limb ischemia (n = 6), femoral thrombus (n = 1), cava inferior thrombus (n = 1), and severe bleeding at the site of cannulation (n = 2). Fifteen patients were weaned off ECLS support and 13 (76%) were discharged to hospital without sequelae.
  
  
  CONCLUSIONS
  Based on our experience, we consider ECLS as a last resort, efficient, and relatively safe therapeutic option in this population. However, the uncontrolled nature of our data requires careful interpretation.
authors.affiliation: Department of Medical Intensive Care, Caen University Hospital, avenue Côte de Nacre, Caen Cedex 14033, France. daubin-c@chu-caen.fr
authors.forename: Cédric
authors.initials: C
authors.lastname: Daubin
authors.forename: Philippe
authors.initials: P
authors.lastname: Lehoux
authors.forename: Calin
authors.initials: C
authors.lastname: Ivascau
authors.forename: Marine
authors.initials: M
authors.lastname: Tasle
authors.forename: Mehdi
authors.initials: M
authors.lastname: Bousta
authors.forename: Olivier
authors.initials: O
authors.lastname: Lepage
authors.forename: Charlotte
authors.initials: C
authors.lastname: Quentin
authors.forename: Massimo
authors.initials: M
authors.lastname: Massetti
authors.forename: Pierre
authors.initials: P
authors.lastname: Charbonneau
mesh_terms: D002315:Cardiopulmonary Bypass; D015331:Cohort Studies; D064420:Drug-Related Side Effects and Adverse Reactions / Q000150:complications / Q000628:therapy*; D005240:Feasibility Studies; D006801:Humans; D016896:Treatment Outcome
references.citation: J Clin Pharmacol. 1996 Aug;36(8):760-3
references.pmid: 8877682
references.citation: Am J Emerg Med. 1994 Jul;12(4):456-8
references.pmid: 8031434
references.citation: Vet Hum Toxicol. 1999 Oct;41(5):326-8
references.pmid: 10509440
references.citation: Lancet. 1986 Jun 21;1(8495):1414-7
references.pmid: 2872519
references.citation: Ann Thorac Surg. 1999 Aug;68(2):655-61
references.pmid: 10475466
references.citation: Anaesthesia. 1991 Sep;46(9):744-6
references.pmid: 1928675
references.citation: Crit Care Med. 2001 Apr;29(4):887-90
references.pmid: 11373489
references.citation: Clin Toxicol (Phila). 2007 Dec;45(8):961-4
references.pmid: 17852155
references.citation: Crit Care Med. 1998 Nov;26(11):1793-800
references.pmid: 9824069
references.citation: Toxicol Rev. 2004;23(4):223-38
references.pmid: 15898828
references.citation: Ann Emerg Med. 1997 May;29(5):680-2
references.pmid: 9140253
references.citation: JAMA. 1993 Dec 22-29;270(24):2957-63
references.pmid: 8254858
references.citation: J Thorac Cardiovasc Surg. 2000 Aug;120(2):424-5
references.pmid: 10917971
references.citation: Ann Thorac Surg. 2005 Jan;79(1):178-83; discussion 183-4
references.pmid: 15620939
references.citation: Arch Mal Coeur Vaiss. 2001 Dec;94(12):1386-92
references.pmid: 11828924
references.citation: J Cardiol. 1998 Aug;32(2):95-100
references.pmid: 9752618
references.citation: Intensive Care Med. 2007 May;33(5):758-764
references.pmid: 17342517
references.citation: Crit Care Med. 1993 Apr;21(4):625-7
references.pmid: 8472584
references.citation: Acad Emerg Med. 2004 Jan;11(1):71-4
references.pmid: 14709431
references.citation: Ann Fr Anesth Reanim. 2009 Feb;28(2):182-90
references.pmid: 19232884
references.citation: Pediatr Emerg Care. 1997 Apr;13(2):111-3
references.pmid: 9127419
references.citation: J Toxicol Clin Toxicol. 1990;28(4):433-44
references.pmid: 2176700
references.citation: Crit Care Med. 1999 Dec;27(12):2818-23
references.pmid: 10628632
references.citation: Anaesth Intensive Care. 1999 Aug;27(4):405-8
references.pmid: 10470398
references.citation: Clin Toxicol (Phila). 2006;44(6-7):803-932
references.pmid: 17015284
references.citation: Eur J Emerg Med. 2007 Apr;14(2):120-2
references.pmid: 17496693
references.citation: Ann Emerg Med. 1991 Aug;20(8):861-74
references.pmid: 1854070
references.citation: Emerg Med J. 2006 Apr;23(4):246-50
references.pmid: 16549566
references.citation: Crit Care. 2007;11(2):207
references.pmid: 17367544
references.citation: Ann Emerg Med. 1994 Mar;23(3):480-6
references.pmid: 8135422
references.citation: J Intensive Care Med. 2007 Nov-Dec;22(6):381-5
references.pmid: 18062140
references.citation: Eur J Clin Pharmacol. 1982;22(2):129-35
references.pmid: 7094983
references.citation: Intensive Care Med. 2006 Sep;32(9):1409-13
references.pmid: 16835785