ECMO for Toxicology

Acute poisoning is a common problem faced by physicians working in emergency units all across the globe.Severe acute toxicity can be lifethreatening or fatal.The death can either be due to cardiovascular or respiratory failure.These toxicities can be accidental, homicidal, or suicidal.Cardiac arrhythmias leading to fatal cardiac arrest, seizures, hypotension, and respiratory depression are some of the features of acute poisoning and can lead to the death of the patient if not treated in a timely manner.The poison profile varies all over the world; with the causative agents being widely different from one part of the world to another.For example, cardiotoxic drugs are common poisons in our country, while pesticides and other household toxins are common in various other domains.Some commonly used patterns of toxicity which are frequently encountered in clinical practice are overdose of medications, drug abuse, ingestion of household or industrial chemicals, and poisoning by plant or animal toxins.In our country, irrespective of the nature of the toxin, the patients affected are relatively young and usually healthy with most of them being bread earners of their families.Extracorporeal life support (ECLS) is increasingly being used as a bridge therapy in the management of acute severe ALP poisoning-induced cardiac arrest or cardiogenic shock.The basic principles in the management of intoxication include decreasing further absorption and increasing elimination of the toxin, administration of antidote, and general supportive measures.The rationale for using ECMO in such cases is to enhance the toxin metabolism and maintenance of adequate cardiac output/oxygenation and tissue perfusion.Despite the evidence of favorable outcomes with ECMO, there are no clear guidelines for the timeline for treatment with ECMO in the existing literature.Hence, it is still not widely used clinically for ALP poisoning.The Extracorporeal Life Support Organization (ELSO) may help in resolving some of these issues since it supports worldwide data collection for the use of ECMO in acute intoxication.