Pozzi Matteo, Koffel Catherine, Djaref Camelia, Grinberg Daniel, Fellahi Jean Luc, Hugon-Vallet Elisabeth, Prieur Cyril, Robin Jacques, Obadia Jean François
Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, "Claude Bernard" University, Lyon, France.
Department of Anesthesia and ICU, "Louis Pradel" Cardiologic Hospital, "Claude Bernard" University, Lyon, France.
J Thorac Dis. 2017 Jul;9(7):1988-1996. doi: 10.21037/jtd.2017.06.81.
Cardiac failure is still a leading cause of death in drug intoxication. Extracorporeal life support (ECLS) could be used as a rescue therapeutic option in patients developing refractory cardiogenic shock or cardiac arrest. The aim of this report is to present our results of ECLS in the setting of poisoning from cardiotoxic drugs.
We included in this analysis consecutive patients who received an ECLS for refractory cardiogenic shock or in-hospital cardiac arrest due to drug intoxication. The primary endpoint of our study was survival to hospital discharge with good neurological recovery after ECLS support.
Between January 2010 and December 2015, we performed 12 ECLS. Mean age was 44.2±17.8 years and there was a predominance of females (66.7%). Drug intoxication was mainly due to beta-blockers and/or calcium channel inhibitors (83.3%) and 5 (41.7%) patients had multiple drugs overdose. Weaning rate and survival to hospital discharge with good neurological recovery were 75% (9 patients). Among patients weaned from ECLS, mean duration of support was 2.4±1.1 days. Three (25%) patients underwent ECLS implantation during cardiopulmonary resuscitation, 2 (66.6%) of them died while on mechanical circulatory support (MCS). Six (50%) patients developed lower limb ischemia. Each patient was managed with ECLS decannulation: 2 (16.7%) patients underwent a concomitant iliofemoral thrombectomy, 3 (25%) needed further fasciotomy and the remaining patient (8.3%) required an amputation.
Refractory cardiogenic shock due to drug intoxication is still one of the best indications for ECLS owing to the satisfactory survival with good neurological outcome in such a critically ill population. Further data are however necessary in order to best understand the possible relation between drug intoxication and lower limb ischemia, which was quite superior to the reported rates.
心力衰竭仍是药物中毒导致死亡的主要原因之一。体外生命支持（ECLS）可作为发生难治性心源性休克或心脏骤停患者的一种抢救治疗选择。本报告旨在介绍我们在心脏毒性药物中毒情况下应用ECLS的结果。
我们纳入了因药物中毒导致难治性心源性休克或院内心脏骤停而接受ECLS治疗的连续患者。我们研究的主要终点是在ECLS支持后存活至出院且神经功能恢复良好。
2010年1月至2015年12月期间，我们实施了12次ECLS。平均年龄为44.2±17.8岁，女性占多数（66.7%）。药物中毒主要由β受体阻滞剂和/或钙通道抑制剂引起（83.3%），5例（41.7%）患者存在多种药物过量。撤机率和存活至出院且神经功能恢复良好的比例为75%（9例患者）。在从ECLS撤机的患者中，平均支持时间为2.4±1.1天。3例（25%）患者在心肺复苏期间接受了ECLS植入，其中2例（66.6%）在机械循环支持（MCS）期间死亡。6例（50%）患者发生下肢缺血。对每位患者进行了ECLS拔管处理：2例（16.7%）患者同时接受了髂股血栓切除术，3例（25%）需要进一步进行筋膜切开术，其余1例患者（8.3%）需要截肢。
由于在这类危重症人群中能获得令人满意的存活且神经功能预后良好，药物中毒导致的难治性心源性休克仍是ECLS的最佳适应证之一。然而，为了更好地理解药物中毒与下肢缺血之间可能的关系，还需要更多数据，下肢缺血的发生率远高于报道的比率。
