title: Extracorporeal Membrane Oxygenation (ECMO) for Severe Toxicological Exposures: Review of the Toxicology Investigators Consortium (ToxIC).
abstract: Although there have been many developments related to specific strategies for treating patients after poisoning exposures, the mainstay of therapy remains symptomatic and supportive care. One of the most aggressive supportive modalities is extracorporeal membrane oxygenation (ECMO). Our goal was to describe the use of ECMO for toxicological exposures reported to the American College of Medical Toxicology (ACMT) Toxicology Investigators Consortium (ToxIC). We performed a retrospective review of the ACMT ToxIC Registry from January 1, 2010 to December 31, 2013. Inclusion criteria included patients aged 0 to 89 years, evaluated between January 2010 through December 2013, and received ECMO for toxicological exposure. There were 26,271 exposures (60 % female) reported to the ToxIC Registry, 10 (0.0004 %) received ECMO: 4 pediatric (< 12 years), 2 adolescent (12-18 years), and 4 adults (>18 years). Time of initiation of ECMO ranged from 4 h to 4 days, with duration from 15 h to 12 days. Exposures included carbon monoxide/smoke inhalation (2), bitter almonds, methanol, and several medications including antihistamines (2), antipsychotic/antidepressant (2), cardiovascular drugs (2), analgesics (2), sedative/hypnotics (2), and antidiabetics (2). Four ECMO patients received cardiopulmonary resuscitation (CPR) during their hospital course, and the overall survival rate was 80 %. ECMO was rarely used for poisoning exposures in the ACMT ToxIC Registry. ECMO was utilized for a variety of ages and for pharmaceutical and non-pharmaceutical exposures. In most cases, ECMO was administered prior to cardiovascular failure, and survival rate was high. If available, ECMO may be a valid treatment modality.
authors.affiliation: Department of Pediatrics, University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, 13123 E 16th Ave B251, Aurora, CO, 80045, USA. george.wang@childrenscolorado.org.|Rocky Mountain Poison and Drug Center, Denver Health Hospital, Denver, CO, USA. george.wang@childrenscolorado.org.
authors.forename: G S
authors.initials: GS
authors.lastname: Wang
authors.affiliation: Department of Emergency Medicine and Medical Toxicology, University of Arizona, Banner Good Samarian Medical Center, Phoenix, AZ, USA.
authors.forename: R
authors.initials: R
authors.lastname: Levitan
authors.affiliation: Department of Emergency Medicine, University of Rochester Medicine, Rochester, NY, USA.
authors.forename: T J
authors.initials: TJ
authors.lastname: Wiegand
authors.affiliation: Division of Clinical Pharmacology, Toxicology and Therapeutic Innovation, Children's Mercy, Kansas City, MO, USA.
authors.forename: J
authors.initials: J
authors.lastname: Lowry
authors.affiliation: Department of Emergency Medicine, University of Rochester Medicine, Rochester, NY, USA.|Department of Pharmacy, University of Rochester Medicine, Rochester, NY, USA.
authors.forename: R F
authors.initials: RF
authors.lastname: Schult
authors.affiliation: Cincinnati Drug and Poison Information Center, Cincinnati, OH, USA.
authors.forename: S
authors.initials: S
authors.lastname: Yin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D011041:Poisoning / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D012042:Registries; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D014116:Toxicology; D016896:Treatment Outcome; D055815:Young Adult
keywords: ACMT ToxIC; ECMO; Exposures; Toxicology