Use of extracorporeal membrane oxygenation in severe cardiotoxic poisoning: Analysis of a cohort over 10 years

Objective The objectives of this study were to identify early risk factors of circulatory assistance by venoarterial extracorporeal membrane oxygenation (VA-ECMO) on admission to intensive care unit (ICU) in population with severe cardiotoxic poisoning and to compare group characteristics with and without assistance. Method All patients included had severe clinical cardiotoxic poisoning, defined by hemodynamic failure requiring treatment with one or more catecholamines, in order to identify factors for circulatory assistance by multivariable logistic regression using bootstrap and supervised hierarchical classifiers methods. This single-center and retrospective study was carried out over 10 years from January 2012 to February 2022. We excluded all the patients with benign poisoning. Results One-hundred forty-six cases were enrolled, including 24 with VA-ECMO (16.4%) and 122 with conventional treatment (83.6%). In circulatory support group, mortality, pneumoniae rate, intensive care length of stay and duration of mechanical ventilation were higher than conventional treatment group. Predictive factors for VA-ECMO on admission were mean arterial pressure ≤ 60 mmHg, lactatemia > 4.1 mmol/L and left ventricular ejection fraction ≤ 20%. The estimation of the classification and regression tree analysis was 91.1%. Conclusions Patients admitted for severe cardiotoxic poisoning presenting with hypotension, hyperlactatemia, and left ventricular dysfunction were more frequently treated with extracorporeal life support, consistent with clinical severity. Early identification of such high-risk profiles is essential to prioritize timely referral to expert centers for optimal management.