ECMO and the poisoned patient: ready for prime time?

veno-venous ECMO 3 out of 5 stars Extracorporeal membrane oxygenation in the treatment of poisoned patients. De Lange DW et al. Clin Toxicol 2013 Jun;51:385-393. Abstract The authors note that although extracorporeal membrane oxygenation (ECMO) had somewhat fallen out of favor, especially for treatment of adult patients, continued improvements in technology have prompted reconsideration of the modality. This renewed interest was also spurred by the low reported mortality among patients with severe acute respiratory distress syndrome (ARDS) treated with ECMO during the 2009 A/H1N1 flu pandemic.(A recent review points out, however, that similar influenza cases treated without ECMO had comparable favorable clinical outcomes.) To evaluate the potential role of ECMO in treating poisoned patients, the authors conducted a literature review, identifying 46 publications consisting of case reports or case series of patients treated with ECMO for various intoxications. They did not find any randomized studies. There are basically two types of ECMO: Veno-venous: potentially useful as a bridge to provide oxygenation and carbon dioxide removal while damage to the respiratory tract heals from irritant or alveolar injury Veno-arterial: potentially provides oxygenation and CO2 removal as well as cardiovascular support in circulatory shock There are no good studies evaluating ECMO vs. standard care in poisoned patients, and most likely there never will be. ECMO is not widely available, so ...
Source: The Poison Review - Category: Toxicology Authors: Tags: Medical ARDS circulatory shock ECMO extracorporeal membrane oxygenation intoxication poisoned patient Source Type: news