Risks of extracorporeal membrane oxygenation: is there a role for use in the management of the acutely poisoned patient?

OBJECTIVE

To review the use of extracorporeal membrane oxygenation in the support of poisoned patients and provide a basis for comparison to other methods of respiratory support for these patients.

METHODS

The medical literature was reviewed and selected cases of poisoning supported by extracorporeal membrane oxygenation and mechanical ventilation highlighted. Data from published outcome studies were reviewed. All cases found were included in the database. Case experiences were critiqued based on available clinical literature. Outcome studies were critiqued with respect to relevancy and bias. Many cases do not provide strong evidence of direct patient benefit. There are no data to support an improvement in outcome among poisoned patients.

CONCLUSION

The use of extracorporeal membrane oxygenation for respiratory failure following ingestion has the same limited indications as for other patients with respiratory failure. Data supporting an improvement in outcome are not available. Extracorporeal membrane oxygenation support for reversible cardiac toxicity has a sound basis but clinical experience is limited. Good supportive care for the poisoned patient is essential before considering extracorporeal membrane oxygenation.