Outcome of patients supported by extracorporeal membrane oxygenation for aluminum phosphide poisoning: An observational study.
BACKGROUND
Aluminum phosphide (AlP) poisoning has a high mortality rate despite intensive care management, primarily because it causes severe myocardial depression and severe acute respiratory distress syndrome. The purpose of this study was to evaluate the impact of the novel use of extracorporeal membrane oxygenation (ECMO), a modified "heart-lung" machine, in a specific subset of AlP poisoning patients who had profound myocardial dysfunction along with either severe metabolic acidosis and/or refractory cardiogenic shock.


METHODS
Between January 2011 and September 2014, 83 patients with AlP poisoning were enrolled in this study; 45 patients were classified as high risk. The outcome of the patients who received ECMO (n=15) was compared with that of patients who received conventional treatment (n=30).


RESULTS
In the high-risk group (n=45), the mortality rate was significantly (p<0.001) lower in patients who received ECMO (33.3%) compared to those who received conventional treatment (86.7%). Compared with the conventional group, the average hospital stay was longer in the ECMO group (p<0.0001). In the ECMO group, non-survivors had a significantly (p=0.01) lower baseline LV ejection fraction (EF) and a significantly longer delay in presentation (p=0.01).


CONCLUSIONS
Veno-arterial ECMO has been shown to improve the short-term survival of patients with AlP poisoning having severe LV myocardial dysfunction. A low baseline LVEF and longer delay in hospital presentation were found to be predictors of mortality even after ECMO usage. Large, adequately controlled and standardized trials with long-term follow-up must be performed to confirm these findings.
Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India. Electronic address: bishav_68@yahoo.co.in.
Bishav
B
Mohan
Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
Bhupinder
B
Singh
Department of Cardiac-Anaesthesia, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
Vivek
V
Gupta
Department of Cardiothoracic Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
Sarju
S
Ralhan
Department of Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
Dinesh
D
Gupta
Department of Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
Sandeep
S
Puri
Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
Abhishek
A
Goyal
Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
Naved
N
Aslam
Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
Rohit
R
Tandon
Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
Gurpreet Singh
GS
Wander
D000328:Adult; D017607:Aluminum Compounds / Q000506:poisoning*; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D010575:Pesticides / Q000506:poisoning; D010720:Phosphines / Q000506:poisoning*; D011446:Prospective Studies; D012770:Shock, Cardiogenic / Q000139:chemically induced / Q000401:mortality / Q000628:therapy*; D015996:Survival Rate / Q000639:trends; D014874:Water Pollutants, Chemical
D017607:Aluminum Compounds; D010575:Pesticides; D010720:Phosphines; D014874:Water Pollutants, Chemical; C001864:aluminum phosphide
Aluminum phosphide poisoning; Extracorporeal membrane oxygenation; Myocardial depression