Progress in the application of extracorporeal membrane oxygenation in acute poisoning_West China Medical Journal

Authors：

LIU Liang , ZHANG Hongxin , GAO Hengbo , CUI Xiaolei ,  TIAN Yingping

Department of Emergency Medicine, the Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, P. R. China;

Corresponding author：

TIAN Yingping, Email: tianyingping-jzh@163.com

Keywords：

Acute poisoning; extracorporeal membrane oxygenation; respiratory failure; circulatory failure; cardiac arrest

DOI：

10.7507/1002-0179.202310089

Video：

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Abstract Full text Figures/Tables Video References Cited by

Acute poisoning is characterized by a sudden and rapid onset, most poisons lack specific antidotes. Even with the full use of blood purification, mechanical ventilation, and various drugs, it is often difficult to change the fatal outcome of critically ill patients. In recent years, extracorporeal membrane oxygenation (ECMO) has gradually gained attention and exploratory application in the treatment of acute poisoning due to its significant cardiopulmonary function support, veno-venous ECMO is used for severe lung injury after poisoning, acute respiratory distress syndrome and respiratory failure due to ineffective mechanical ventilation, and it can also be used to assist the removal of residual poisons in the lungs. Veno-arterial ECMO is commonly employed in patients with circulatory failure following poisoning, fatal cardiac arrhythmias, and arrest of cardiac and respiratory. The application of veno-arterio-venous ECMO has also been reported. The mode of ECMO necessitates timely adjustments according to the evolving illness, while ongoing exploration of additional clinical indications is underway. This review analyzes and evaluates the application scope and effectiveness of ECMO in acute poisoning in recent years, with a view to better exploring and rationalizing the use of this technology.

Citation： LIU Liang, ZHANG Hongxin, GAO Hengbo, CUI Xiaolei, TIAN Yingping. Progress in the application of extracorporeal membrane oxygenation in acute poisoning. West China Medical Journal, 2023, 38(11): 1742-1747. doi: 10.7507/1002-0179.202310089 Copy

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2.	Maier S, Rösner L, Saemann L, et al. Extracorporeal membrane oxygenation in intoxication and overdoses: a systematic review. Thorac Cardiovasc Surg, 2023: 20.
3.	de Lange DW, Sikma MA, Meulenbelt J. Extracorporeal membrane oxygenation in the treatment of poisoned patients. Clin Toxicol (Phila), 2013, 51(5): 385-393.
4.	Ius F, Sommer W, Tudorache I, et al. Veno-veno-arterial extracorporeal membrane oxygenation for respiratory failure with severe haemodynamic impairment: technique and early outcomes. Interact Cardiovasc Thorac Surg, 2015, 20(6): 761-767.
5.	兰超, 吕青. ECMO 救治急性重症中毒患者的治疗进展. 中国急救医学, 2021, 41(7): 621-623.
6.	辛萌, 谢海秀, 杜中涛, 等. 体外膜肺氧合在中国急性中毒成人患者中的应用: 2017-2021 年体外生命支持登记的回顾性分析. 中华急诊医学杂志, 2022, 31(12): 1597-1602.
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8.	Baran DA, Stelling K, McQueen D, et al. Pediatric veno-veno extracorporeal membrane oxygenation rescue from carbon monoxide poisoning. Pediatr Emerg Care, 2020, 36(10): e592-e594.
9.	Kummer RL, Kempainen RR, Olives TD, et al. Naloxone-associated pulmonary edema following recreational opioid overdose. Am J Emerg Med, 2022, 53: 41-43.
10.	Cho YS, Moon JM, Jeong YH, et al. Successful extracorporeal life support in respiratory failure after copper sulphate ingestion. Natl Med J India, 2018, 31(2): 83-85.
11.	Ho A, Go A, Barrios C, et al. Severe noncardiogenic pulmonary edema secondary to massive verapamil overdose and treatment with venovenous extracorporeal membrane oxygenation. Case Rep Crit Care, 2020, 2020: 8842303.
12.	Haughey R, Vernick W, Gutsche J, et al. Use of veno-venous extracorporeal membrane oxygenation to treat severe combined calcium channel blocker and angiotensin converting enzyme inhibitor overdose. Perfusion, 2019, 34(2): 167-169.
13.	叶铨秋, 陈晓燕, 鲁玫, 等. VV-ECMO 救治急性氮氧化物中毒致重度 ARDS 1 例报道. 现代医药卫生, 2023, 39(5): 898-900.
14.	张政. 3 种刺激性气体中毒临床治疗现状. 锦州医科大学学报, 2021, 42(5): 105-109.
15.	陆欢, 刘奇, 兰超. ECMO 在氨气中毒致急性呼吸衰竭患者中的应用. 中华危重病急救医学, 2019, 31(12): 1542-1544.
16.	Li C, Cai H, Meng F, et al. Case report: lung transplantation for treatment of paraquat intoxication: timing of transplantation. Front Pharmacol, 2023, 14: 1205689.
17.	张云, 张晶, 高霏, 等. ECMO 在农药中毒救治中的应用. 中国急救复苏与灾害医学杂志, 2020, 15(12): 1466-1470.
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21.	急性一氧化碳中毒诊治专家共识组. 急性一氧化碳中毒诊治专家共识. 中华物理医学与康复杂志, 2022, 44(6): 481-486.
22.	马传根, 赵冬梅, 赵景霞. 体外膜肺氧合治疗重度一氧化碳中毒(附 6 例报告). 急诊医学, 2000, 9(4): 266-267.
23.	Yu D, Xiaolin Z, Lei P, et al. Extracorporeal membrane oxygenation for acute toxic inhalations: case reports and literature review. Front Med (Lausanne), 2021, 8: 745555.
24.	孙阳阳, 骆媛, 王永安. 细胞因子在百草枯中毒致肺纤维化中的作用研究进展. 中国药理学与毒理学杂志, 2021, 35(7): 551-558.
25.	Kojidi HM, Attarchi M, Rahbar-Taramsari M, et al. Aluminum phosphide poisoning in the north of iran: a register-based research. Curr Drug Saf, 2023, 18(3): 323-334.
26.	菅向东, 张忠臣. 急性中毒致多器官功能障碍与休克. 实用休克杂志(中英文), 2018, 2(4): 204-207.
27.	孙承业. 实用急性中毒全书. 2 版. 北京: 人民卫生出版社, 2020: 16.
28.	李荣凌, 周本宏. 秋水仙碱中毒死亡及致急性冠脉综合征与中毒性心肌炎 1 例. 中国医院药学杂志, 2021, 41(4): 434-436.
29.	高三花, 王永田, 刘卫斌, 等. 营养心肌治疗对急性有机磷农药中毒并发中毒性心肌炎患者心肌保护作用的临床观察. 河北医药, 2017, 39(15): 2308-2310.
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31.	张帅, 菅向东, 吴强, 等. 蓖麻子中毒致休克一例. 中华卫生应急电子杂志, 2016, 2(3): 194-194.
32.	梁晓. 氯丙嗪治疗顽固性呃逆致休克 1 例. 临床合理用药杂志, 2012, 5(35): 46, 48.
33.	吴小伟, 田懿. 蜂毒中毒致过敏性休克死亡鉴定 1 例. 中国法医学杂志, 2022, 37(2): 205, 208.
34.	董伟, 邢燕, 史长松. β内酰胺类抗菌药物导致过敏性休克合并横纹肌溶解综合征 1 例. 中国医药, 2022, 17(9): 1413-1414.
35.	Graudins A, Lee HM, Druda D. Calcium channel antagonist and beta-blocker overdose: antidotes and adjunct therapies. Br J Clin Pharmacol, 2016, 81(3): 453-461.
36.	Hendren WG, Schieber RS, Garrettson LK. Extracorporeal bypass for the treatment of verapamil poisoning. Ann Emerg Med, 1989, 18(9): 984-987.
37.	Freedman MD, Gal J, Freed CR. Extracorporeal pump assistance--novel treatment for acute lidocaine poisoning. Eur J Clin Pharmacol, 1982, 22(2): 129-135.
38.	Larkin GL, Graeber GM, Hollingsed MJ. Experimental amitriptyline poisoning: treatment of severe cardiovascular toxicity with cardiopulmonary bypass. Ann Emerg Med, 1994, 23(3): 480-486.
39.	Pozzi M, Buzzi R, Hayek A, et al. Veno-arterial extracorporeal membrane oxygenation for drug intoxications: a single center, 14-year experience. J Card Surg, 2022, 37(6): 1512-1519.
40.	张云, 张晶, 高霏, 等. ECMO 在心血管药物中毒救治中的应用. 临床急诊杂志, 2020, 21(10): 832-839.
41.	赵知文, 周江, 黄明菁, 等. 体外膜肺氧合救治乌头碱中毒 1 例. 中国临床案例成果数据库, 2023, 5(1): E00592.
42.	Yasuda S, Hisamura M, Hirano T, et al. Caffeine poisoning successfully treated by venoarterial extracorporeal membrane oxygenation and emergency hemodialysis. Acute Med Surg, 2021, 8(1): e627.
43.	Okuda H, Fukushima H, Nakatsukasa T, et al. Fatal poisoning due to ingestion of boiled oleander leaf extract. J Forensic Sci, 2023: 27.
44.	李奇, 段颖杰, 李莲叶, 等. 4 例重度婴儿肉毒杆菌毒素中毒患儿的救治与护理. 中国急救复苏与灾害医学杂志, 2022, 17(12): 1677-1680.
45.	黄韵清, 周玉淑, 刘仁术, 等. 现代急性中毒诊断治疗学. 北京: 人民军医出版社, 2002: 66-69, 76-104.
46.	张茂, 徐杰丰. 关注特殊情况下心脏骤停的复苏. 华西医学, 2019, 34(11): 1211-1216.
47.	胡苗, 熊滨, 韩林, 等. 以心脏骤停为主要症状的致死性蘑菇中毒二例报告并文献复习. 中国临床新医学, 2022, 15(3): 260-263.
48.	Li Y, Qiu Z, Huang L, et al. Extracorporeal membrane oxygenation combined with sequential blood purification in the treatment of myocardial damage and cardiac arrest caused by mushroom poisoning. Toxicon, 2021, 197: 65-69.
49.	Le HY, Tien ND, Son PN, et al. Extracorporeal membrane oxygenation support in refractory anaphylactic shock after bee stings: a case report. Perfusion, 2023, 38(6): 1308-1310.
50.	Baud F, Lamhaut L, Jouffoy R, et al. Peripheral circulatory support in acute poisoning: 10 years’ experience. Emergencias, 2016, 28(4): 252-262.
51.	Kim M, Shin SD, Jeong S, et al. Poisoning-induced out-of-hospital cardiac arrest and outcomes according to poison agent. J Korean Med Sci, 2017, 32(12): 2042-2050.
52.	Mégarbane B, Leprince P, Deye N, et al. Emergency feasibility in medical intensive care unit of extracorporeal life support for refractory cardiac arrest. Intensive Care Med, 2007, 33(5): 758-764.
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1. 张驭涛, 蒋绍锋, 郎楠, 等. 2017-2021 年我国急性化学品中毒病例特征分析. 职业卫生与应急救援, 2023, 41(1): 43-48.
2. Maier S, Rösner L, Saemann L, et al. Extracorporeal membrane oxygenation in intoxication and overdoses: a systematic review. Thorac Cardiovasc Surg, 2023: 20.
3. de Lange DW, Sikma MA, Meulenbelt J. Extracorporeal membrane oxygenation in the treatment of poisoned patients. Clin Toxicol (Phila), 2013, 51(5): 385-393.
4. Ius F, Sommer W, Tudorache I, et al. Veno-veno-arterial extracorporeal membrane oxygenation for respiratory failure with severe haemodynamic impairment: technique and early outcomes. Interact Cardiovasc Thorac Surg, 2015, 20(6): 761-767.
5. 兰超, 吕青. ECMO 救治急性重症中毒患者的治疗进展. 中国急救医学, 2021, 41(7): 621-623.
6. 辛萌, 谢海秀, 杜中涛, 等. 体外膜肺氧合在中国急性中毒成人患者中的应用: 2017-2021 年体外生命支持登记的回顾性分析. 中华急诊医学杂志, 2022, 31(12): 1597-1602.
7. 中国医师协会急诊医师分会, 中国毒理学会中毒与救治专业委员会. 急性中毒诊断与治疗中国专家共识. 中华急诊医学杂志, 2016, 25(11): 1361-1375.
8. Baran DA, Stelling K, McQueen D, et al. Pediatric veno-veno extracorporeal membrane oxygenation rescue from carbon monoxide poisoning. Pediatr Emerg Care, 2020, 36(10): e592-e594.
9. Kummer RL, Kempainen RR, Olives TD, et al. Naloxone-associated pulmonary edema following recreational opioid overdose. Am J Emerg Med, 2022, 53: 41-43.
10. Cho YS, Moon JM, Jeong YH, et al. Successful extracorporeal life support in respiratory failure after copper sulphate ingestion. Natl Med J India, 2018, 31(2): 83-85.
11. Ho A, Go A, Barrios C, et al. Severe noncardiogenic pulmonary edema secondary to massive verapamil overdose and treatment with venovenous extracorporeal membrane oxygenation. Case Rep Crit Care, 2020, 2020: 8842303.
12. Haughey R, Vernick W, Gutsche J, et al. Use of veno-venous extracorporeal membrane oxygenation to treat severe combined calcium channel blocker and angiotensin converting enzyme inhibitor overdose. Perfusion, 2019, 34(2): 167-169.
13. 叶铨秋, 陈晓燕, 鲁玫, 等. VV-ECMO 救治急性氮氧化物中毒致重度 ARDS 1 例报道. 现代医药卫生, 2023, 39(5): 898-900.
14. 张政. 3 种刺激性气体中毒临床治疗现状. 锦州医科大学学报, 2021, 42(5): 105-109.
15. 陆欢, 刘奇, 兰超. ECMO 在氨气中毒致急性呼吸衰竭患者中的应用. 中华危重病急救医学, 2019, 31(12): 1542-1544.
16. Li C, Cai H, Meng F, et al. Case report: lung transplantation for treatment of paraquat intoxication: timing of transplantation. Front Pharmacol, 2023, 14: 1205689.
17. 张云, 张晶, 高霏, 等. ECMO 在农药中毒救治中的应用. 中国急救复苏与灾害医学杂志, 2020, 15(12): 1466-1470.
18. Ramanathan K, Tan CS, Rycus P, et al. Extracorporeal membrane oxygenation for poisoning in adult patients: outcomes and predictors of mortality. Intensive Care Med, 2017, 43(10): 1538-1539.
19. 中国医师协会急诊医师分会, 中国急诊专科医联体, 中国医师协会急救复苏和灾难医学专业委员会, 等. 刺激性气体中毒诊治专家共识. 中华急诊医学杂志, 2020, 29(12): 1527-1536.
20. Perl M, Lomas-Neira J, Venet F, et al. Pathogenesis of indirect (secondary) acute lung injury. Expert Rev Respir Med, 2011, 5(1): 115-126.
21. 急性一氧化碳中毒诊治专家共识组. 急性一氧化碳中毒诊治专家共识. 中华物理医学与康复杂志, 2022, 44(6): 481-486.
22. 马传根, 赵冬梅, 赵景霞. 体外膜肺氧合治疗重度一氧化碳中毒(附 6 例报告). 急诊医学, 2000, 9(4): 266-267.
23. Yu D, Xiaolin Z, Lei P, et al. Extracorporeal membrane oxygenation for acute toxic inhalations: case reports and literature review. Front Med (Lausanne), 2021, 8: 745555.
24. 孙阳阳, 骆媛, 王永安. 细胞因子在百草枯中毒致肺纤维化中的作用研究进展. 中国药理学与毒理学杂志, 2021, 35(7): 551-558.
25. Kojidi HM, Attarchi M, Rahbar-Taramsari M, et al. Aluminum phosphide poisoning in the north of iran: a register-based research. Curr Drug Saf, 2023, 18(3): 323-334.
26. 菅向东, 张忠臣. 急性中毒致多器官功能障碍与休克. 实用休克杂志(中英文), 2018, 2(4): 204-207.
27. 孙承业. 实用急性中毒全书. 2 版. 北京: 人民卫生出版社, 2020: 16.
28. 李荣凌, 周本宏. 秋水仙碱中毒死亡及致急性冠脉综合征与中毒性心肌炎 1 例. 中国医院药学杂志, 2021, 41(4): 434-436.
29. 高三花, 王永田, 刘卫斌, 等. 营养心肌治疗对急性有机磷农药中毒并发中毒性心肌炎患者心肌保护作用的临床观察. 河北医药, 2017, 39(15): 2308-2310.
30. 王停停, 刘清岳, 孙甲君. 静脉-动脉体外膜肺氧合救治敌敌畏中毒致难治性休克 3 例. 中华劳动卫生职业病杂志, 2023, 41(9): 688-692.
31. 张帅, 菅向东, 吴强, 等. 蓖麻子中毒致休克一例. 中华卫生应急电子杂志, 2016, 2(3): 194-194.
32. 梁晓. 氯丙嗪治疗顽固性呃逆致休克 1 例. 临床合理用药杂志, 2012, 5(35): 46, 48.
33. 吴小伟, 田懿. 蜂毒中毒致过敏性休克死亡鉴定 1 例. 中国法医学杂志, 2022, 37(2): 205, 208.
34. 董伟, 邢燕, 史长松. β内酰胺类抗菌药物导致过敏性休克合并横纹肌溶解综合征 1 例. 中国医药, 2022, 17(9): 1413-1414.
35. Graudins A, Lee HM, Druda D. Calcium channel antagonist and beta-blocker overdose: antidotes and adjunct therapies. Br J Clin Pharmacol, 2016, 81(3): 453-461.
36. Hendren WG, Schieber RS, Garrettson LK. Extracorporeal bypass for the treatment of verapamil poisoning. Ann Emerg Med, 1989, 18(9): 984-987.
37. Freedman MD, Gal J, Freed CR. Extracorporeal pump assistance--novel treatment for acute lidocaine poisoning. Eur J Clin Pharmacol, 1982, 22(2): 129-135.
38. Larkin GL, Graeber GM, Hollingsed MJ. Experimental amitriptyline poisoning: treatment of severe cardiovascular toxicity with cardiopulmonary bypass. Ann Emerg Med, 1994, 23(3): 480-486.
39. Pozzi M, Buzzi R, Hayek A, et al. Veno-arterial extracorporeal membrane oxygenation for drug intoxications: a single center, 14-year experience. J Card Surg, 2022, 37(6): 1512-1519.
40. 张云, 张晶, 高霏, 等. ECMO 在心血管药物中毒救治中的应用. 临床急诊杂志, 2020, 21(10): 832-839.
41. 赵知文, 周江, 黄明菁, 等. 体外膜肺氧合救治乌头碱中毒 1 例. 中国临床案例成果数据库, 2023, 5(1): E00592.
42. Yasuda S, Hisamura M, Hirano T, et al. Caffeine poisoning successfully treated by venoarterial extracorporeal membrane oxygenation and emergency hemodialysis. Acute Med Surg, 2021, 8(1): e627.
43. Okuda H, Fukushima H, Nakatsukasa T, et al. Fatal poisoning due to ingestion of boiled oleander leaf extract. J Forensic Sci, 2023: 27.
44. 李奇, 段颖杰, 李莲叶, 等. 4 例重度婴儿肉毒杆菌毒素中毒患儿的救治与护理. 中国急救复苏与灾害医学杂志, 2022, 17(12): 1677-1680.
45. 黄韵清, 周玉淑, 刘仁术, 等. 现代急性中毒诊断治疗学. 北京: 人民军医出版社, 2002: 66-69, 76-104.
46. 张茂, 徐杰丰. 关注特殊情况下心脏骤停的复苏. 华西医学, 2019, 34(11): 1211-1216.
47. 胡苗, 熊滨, 韩林, 等. 以心脏骤停为主要症状的致死性蘑菇中毒二例报告并文献复习. 中国临床新医学, 2022, 15(3): 260-263.
48. Li Y, Qiu Z, Huang L, et al. Extracorporeal membrane oxygenation combined with sequential blood purification in the treatment of myocardial damage and cardiac arrest caused by mushroom poisoning. Toxicon, 2021, 197: 65-69.
49. Le HY, Tien ND, Son PN, et al. Extracorporeal membrane oxygenation support in refractory anaphylactic shock after bee stings: a case report. Perfusion, 2023, 38(6): 1308-1310.
50. Baud F, Lamhaut L, Jouffoy R, et al. Peripheral circulatory support in acute poisoning: 10 years’ experience. Emergencias, 2016, 28(4): 252-262.
51. Kim M, Shin SD, Jeong S, et al. Poisoning-induced out-of-hospital cardiac arrest and outcomes according to poison agent. J Korean Med Sci, 2017, 32(12): 2042-2050.
52. Mégarbane B, Leprince P, Deye N, et al. Emergency feasibility in medical intensive care unit of extracorporeal life support for refractory cardiac arrest. Intensive Care Med, 2007, 33(5): 758-764.
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