Extracorporeal cardio-pulmonary resuscitation in poisoning: A scoping review article

Background: Extracorporeal cardiopulmonary resuscitation (ECPR) represents last-line salvage therapy for poisoning-induced cardiac arrest but no review has focused on this specific area. Objective: This scoping review sought to evaluate the survival outcomes and characteristics of published cases of ECPR for toxicological arrest, with the aim of highlighting the potential and limitations of ECPR in toxicology. Eligibility Criteria. We searched PubMed and Cochrane for eligible papers from database inception to October 1, 2022 using the keywords toxicology, ECLS and CPR. References of included publications were searched to identify additional relevant articles. Qualitative synthesis was used to summarize the evidence. Results: 85 articles were chosen: 15 case series, 58 individual cases and 12 other publications that were analyzed separately due to ambiguity. ECPR may improve survival outcomes in selected poisoned patients, although the extent of benefit is unclear. As ECPR for poisoning-induced arrest may have better prognosis compared to from other aetiologies, it is likely reasonable to apply ELSO ECPR consensus guideline recommendations to toxicological arrest. Out-of-hospital cardiac arrest alone may not be sufficient grounds to deny ECPR if effective resuscitation had been promptly instituted. Poisonings involving membrane-stabilizing agents and cardio-depressive drugs, and cardiac arrests with shockable rhythms appear to have better outcomes. ECPR may permit excellent neurologically-intact recovery despite prolonged low-flow time of up to four hours. Early ECLS activation and pre-emptive catheter placement can significantly shorten time-to-ECPR and possibly improve survival. Conclusion: As effects of poisoning may be reversible, ECPR can potentially support poisoned patients through the critical peri-arrest state.

Automated summary

This scoping review evaluated the survival outcomes and characteristics of ECPR for toxicological arrest, finding that it may improve survival outcomes in selected poisoned patients. Poisonings involving membrane-stabilizing agents and cardio-depressive drugs, and cardiac arrests with shockable rhythms appear to have better outcomes. Early ECLS activation and pre-emptive catheter placement can significantly shorten time-to-ECPR and possibly improve survival.