Key result
VA-ECMO reduced in-hospital mortality compared to conventional treatment in high-risk patients with aluminium phosphide poisoning (40% vs 84.4%; OR 0.47; 95% CI 0.31-0.73).
Why the study?
Aluminium phosphide poisoning has high mortality when complicated by myocardial dysfunction and refractory shock or severe acidosis, prompting study of veno-arterial extra-corporeal membrane oxygenation.
Does VA-ECMO reduce in-hospital mortality in high-risk patients with Aluminium phosphide poisoning complicated with myocardial dysfunction?
Cohort (n=67)
No
Does VA-ECMO reduce in-hospital mortality in high-risk patients with Aluminium phosphide poisoning complicated with myocardial dysfunction?
VA-ECMO significantly reduces in-hospital mortality in high-risk patients with Aluminium phosphide poisoning complicated by myocardial dysfunction.
Answers are grounded in this paper and cite their sources.
May support VA-ECMO in severe aluminium phosphide poisoning; leaves open need for randomized confirmation.
Background: Aluminium phosphide (AlP) poisoning is associated with a high mortality rate when patients are complicated with myocardial dysfunction and refractory shock or severe metabolic acidosis. We studied the role of veno-arterial extra-corporeal membrane oxygenation (VA-ECMO) in patients of AlP poisoning induced myocardial dysfunction.Methods and results: This is a tertiary care, single-centre, retrospective study. Between January 2011 and June 2016, total of 107 patients with AlP poisoning were identified and of those 67 were categorised in high-risk category as per the criteria. The in-hospital mortality of patients who received ECMO (n = 35) was compared to those who received conventional treatment (n = 32) only. The use of ECMO in addition to conventional treatment has reduced the in-hospital mortality from 84.4% to 40% (odds ratio: 0.47; 95% confidence interval 0.31–0.73). Among survivors, the ECMO group had a significantly lower baseline left ventricular ejection fraction (LVEF; median: 24%; IQR: 22–29 vs. median: 32%; IQR: 32–33.5; p < .003) but a non-significantly higher LVEF at the time of discharge (median: 52%; IQR: 48–60 vs. median: 48%; IQR: 47–49; p: .064) than did the conventional group. On logistic regression analysis the higher sequential organ failure assessment (SOFA) score, lower pH and the non-usage of ECMO were found to be the independent predictors of mortality.Conclusion: The use of ECMO in high-risk patient of AlP poisoning has resulted in a significant reduction in the mortality. A high baseline SOFA score has been found to be the independent predictor of mortality.
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Mohan et al. (2019) conducted a cohort in Aluminium phosphide poisoning with myocardial dysfunction (n=67). Veno-arterial extra-corporeal membrane oxygenation (VA-ECMO) vs. Conventional treatment was evaluated on In-hospital mortality (OR 0.47, 95% CI 0.31-0.73). VA-ECMO reduced in-hospital mortality compared to conventional treatment in high-risk patients with aluminium phosphide poisoning (40% vs 84.4%; OR 0.47; 95% CI 0.31-0.73).
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