Veno‐arterial extracorporeal membrane oxygenation for drug intoxications: A single center, 14‐year experience.

Background and Aim of the Study: Acute cardiovascular failure remains a leading cause of death in severe poisonings. Veno‐arterial extracorporeal membrane oxygenation (VA‐ECMO) has been increasingly used as a rescue therapeutic option for those cases refractory to optimal conventional treatment. We sought to evaluate the outcomes after VA‐ECMO used for drug intoxications in a single‐center experience. Methods: We performed an observational analysis of our prospective institutional database. The primary endpoint was survival to hospital discharge. Results: Between January 2007 and December 2020, 32 patients (mean age: 45.4 ± 15.8 years; 62.5% female) received VA‐ECMO for drug intoxication‐induced refractory cardiogenic shock (n = 25) or cardiac arrest (n = 7). Seven (21.8%) patients developed lower limb ischemia during VA‐ECMO support. Twenty‐six (81.2%) patients were successfully weaned after a mean VA‐ECMO support of 2.9 ± 1.3 days. One (3.1%) patient died after VA‐ECMO weaning for multiorgan failure and survival to hospital discharge was 78.1% (n = 25). In‐hospital survivors were discharged from hospital with a good neurological status. Survival to hospital discharge was not statistically different according to sex (male = 75.0% vs. female = 80.0%; p =.535), type of intoxication (single drug = 81.8% vs. multiple drugs = 76.1%; p =.544) and location of VA‐ECMO implantation (within our center = 75% vs. peripheral hospital using our Mobile Unit of Mechanical Circulatory Support = 100%; p =.352). Survival to hospital discharge was significantly lower in patients receiving VA‐ECMO during on‐going cardiopulmonary resuscitation (42.8% vs. 88.0%; p =.026). Conclusions: VA‐ECMO appears to be a feasible therapeutic option with a satisfactory survival rate and acceptable complications rate in poisonings complicated by refractory cardiogenic shock or cardiac arrest. [ABSTRACT FROM AUTHOR]