Prognosis factors of poisonings treated with extracorporeal life support in the ICU

Introduction

Massive drug ingestions may be associated with refractory cardiac failure, which reversibility makes extracorporeal life support (ECLS) promising despite prolonged arrest. Our objective was to determine the prognosis factors of ECLS-treated patients.

Methods

A prospective study including all poisoned patients treated with ECLS during 2003–2007; surgical cannulation of femoral vessels in the ICU to perform ECLS (Rotaflow^®; Jostra-Maquet SA) in collaboration with a cardiosurgical team of a neighboring hospital. Descriptive analysis (median, (percentiles 10–90%)); univariate comparisons using chi-squared and Mann–Whitney tests.

Results

Fifty-seven poisoned patients (19 males/38 females, 41 years (21–59); SAPS II, 75 (49–94)) were treated with ECLS over a 4–year period in relation to cardiac failure (26/57) and arrest (31/57). Patients had ingested high doses of cardiotoxicants in 49/57 cases (chloroquine 19%, class I antiarrhythmic drugs 19%, β-blockers 14%, calcium channel blockers 11%). Sixteen patients (28%) survived, including five to prolonged cardiac arrest (maximal duration: 180 min). Death was consecutive to multiorgan failure, anoxic encephalopathy or capillary leak syndrome if ECLS was performed under cardiac massage. Four patients presented documented brain death, allowing organ donation in two cases. Among these patients, the heart of one flecainide-poisoned patient was successfully transplanted, after normalization of ECG and myocardial function as well as toxicant elimination under ECLS. Prognosis factors in ECLS-treated poisoned patients were as follows: QRS enlargement on admission (P = 0.009), SAPS II score on admission (P = 0.005), ECLS performance under massage (P = 0.008), arterial pH (P < 0.001), lactate concentration (10.7 (6.6–19.6) versus 15.0 mmol/l (6.2–29.5), P = 0.003), as well as red cell (P = 0.008), fresh plasma (P = 0.003), and platelet (P = 0.03) transfusions within the first 24 hours.

Conclusion

ECLS appears to be an efficient salvage technique in cases of refractory toxic cardiac failure or arrest.