CHU de Caen, Department of Medical Intensive Care, Caen F-14000, France.
Resuscitation. 2012 Nov;83(11):1413-7. doi: 10.1016/j.resuscitation.2012.03.028. Epub 2012 Mar 31.
The use of extracorporeal life support (ECLS) as a treatment for severe cardiovascular impairment due to poisoning is unclear. Therefore, we conducted a retrospective cohort analysis to compare survival among critically ill poisoned patients treated with or without ECLS.
All consecutive patients admitted into 2 university hospitals in northwestern France over the past decade for persistent cardiac arrest or severe shock following poisoning due to drug intoxication were included. ECLS was preferentially performed in 1 of the 2 centers.
Sixty-two patients (39 women, 23 men; mean age 48±17 years) fulfilled inclusion criteria: 10 with persistent cardiac arrest and 42 with severe shock. Fourteen patients were treated with ECLS and 48 patients with conventional therapies. All subjects received vasopressor and fluid loading. Patients treated with or without ECLS at ICU admission had comparable drug ingestion histories, Simplified Acute Physiology Score (SAPS II score) (66±18), Sequential Organ Failure Assessment (SOFA) score (median: 11 [IQR, 9-13]), Glasgow Coma Scale score (median: 3 [IQR, 3-11]), need for ventilator support (n=56) and extra renal support (n=23). Thirty-five (56%) patients survived: 12/14 (86%) ECLS patients and 23/48 (48%) non-ECLS patients (p=0.02, by Fisher exact test). None of the patients with persistent cardiac arrest survived without ECLS support. Based on admission data, beta-blocker intoxication (p=0.02) was also associated with lower mortality. In multivariate analysis, adjusting for SAPS II and beta-blocker intoxication, ECLS support remained associated with lower mortality [Adjusted Odds Ratio, 0.18; 95% CI, 0.03-0.96; p=0.04].
In the absence of response to conventional therapies, we consider that ECLS may improve survival in critically ill poisoned patients experiencing cardiac arrest and severe shock.
体外生命支持（ECLS）在治疗因中毒导致的严重心血管损伤中的应用尚不清楚。因此，我们进行了一项回顾性队列分析，比较了接受或不接受 ECLS 治疗的中毒性重症患者的存活率。
纳入了过去十年内在法国西北部的 2 所大学医院接受治疗的因药物中毒持续心脏骤停或严重休克的所有连续患者。ECLS 优先在其中 1 家中心进行。
62 名患者（39 名女性，23 名男性；平均年龄 48±17 岁）符合纳入标准：10 名持续心脏骤停，42 名严重休克。14 名患者接受了 ECLS 治疗，48 名患者接受了常规治疗。所有患者均接受了血管加压素和液体负荷。入住 ICU 时接受或不接受 ECLS 治疗的患者药物摄入史相似，简化急性生理学评分（SAPS II 评分）（66±18）、序贯器官衰竭评估（SOFA）评分（中位数：11 [IQR，9-13]）、格拉斯哥昏迷量表评分（中位数：3 [IQR，3-11]）、需要呼吸机支持（n=56）和肾脏外支持（n=23）。35 名（56%）患者存活：14 名 ECLS 患者中的 12 名（86%）和 48 名非 ECLS 患者中的 23 名（48%）（Fisher 确切检验，p=0.02）。没有一名持续心脏骤停的患者在没有 ECLS 支持的情况下存活。基于入院数据，β-受体阻滞剂中毒（p=0.02）也与死亡率降低相关。多变量分析中，调整 SAPS II 和β-受体阻滞剂中毒后，ECLS 支持仍与死亡率降低相关[调整后的优势比，0.18；95%置信区间，0.03-0.96；p=0.04]。
在常规治疗无反应的情况下，我们认为 ECLS 可提高发生心脏骤停和严重休克的中毒性重症患者的存活率。
