ECMO in Poisoning Gupta and Wander Review Article ECMO in Poisoning Vivek Gupta 1 Gurpreet S. Wander 2 1 Department of Cardiac Anaesthesia and Intensive care, Hero DMC Heart Institute, Ludhiana, Punjab, India 2 Department of Cardiology, Hero DMC Heart Institute, Ludhiana, Punjab, India Address for correspondence Vivek Gupta, MD, Department of Cardiac Anaesthesia and Intensive care, Hero DMC Heart Institute, Tagore Nagar, Ludhiana, Punjab 141001, India (e-mail: dr_vivekg@yahoo.com). Severe poisoning may lead to life-threatening situation or death due to cardiovascular dysfunction, arrhythmia, or cardiogenic shock. The poisoning substance varies in dif- ferent parts of world; in the Western world, the drugs with cardiotoxic potential are more common, while pesticides and other household toxins are common in the rest of the world. However, most of these patients are relatively young and otherwise healthy irrespective of poisoning substances. Extracorporeal membrane oxygenation (ECMO) has regained interest in recent past and now its use is being explored for newer indi- cations. The use of ECMO in poisoning has shown promising results as salvage therapy and can be used as bridge to recovery, antidote, and toxin removal with renal replace- ment therapy or transplant. The ECMO has been used in those poisoned patients who have persistent cardiogenic shock or refractory hypoxemia despite adequate support- ive therapy. ECMO may be useful in providing adequate cardiac output and maintain tissue perfusion which helps in the redistribution of toxins from central circulation and facilitate the metabolism and excretion. However, the available literature is not suffi- cient and is based on case reports, case series, and retrospective cohort study. In spite of high mortality with severe poisoning and encouraging outcome with use of ECMO, it is an underutilized modality across the world. Though evidences suggest that early consideration of ECMO in severely poisoned patients with refractory cardiac arrest or hemodynamic compromise refractory to standard therapies may be beneficial, the right time to start ECMO in poisoned patients, criteria to start ECMO, and prognostica- tion prior to initiation of ECMO is yet to be answered. Future studies and publications may address these issues, whereas the ELSO (Extracorporeal Life Support Organiza- tion) data registry may help in collecting global data on poisoning more effectively. Abstract Keywords ► ECMO ► ECLS ► ECPB ► intoxication ► poisoning J Card Crit Care TSS 2017;1:82–88 DOI https://doi.org/ 10.1055/s-0038-1626679. ISSN 2457-0206. Copyright © 2017 Official Publication of The Simulation Society (TSS), accredited by International Society of Cardiovascular Ultrasound (ISCU) “All substances are poisons; there is none that is not a poison; “The right dose differentiates a poison from a remedy” Paracelsus Introduction Globally, acute poisoning with medications or other toxic substances is a common presentation to emergency depart- ment. 1 Conventional supportive therapy and specific antidotes administration are usually effective but may not be sufficient in cases of cardiovascular collapse due to life-threatening overdoses. Children are usually the victim of accidental over- doses and symptoms are usually apparent immediately while adult intoxication is usually deliberate and present late to emergency department. 2 Poisoning-associated deaths both due to accidental inges- tion and ingestion for self-harm have increased in the last few years. More than 5,000 poisoned patients are visiting emergency departments every day across the United States and unintentional poisoning is a significant cause of mortal- ity, even exceeding road traffic accidents as a cause of death in the younger and middle age group. The poisoning victims are usually young though toxic substances varies across the world. 3,4 82