Use of extracorporeal membrane oxygenation for severe toxicological exposure

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Abstract
Background: Extracorporeal membrane oxygenation (ECMO) is used in Hong Kong to provide additional circulation and respiratory support to patients. Exposure to toxins could cause profound shock and respiratory failure. The role of using ECMO to support severe circulatory and respiratory failure in patients with a toxicological cause of admission in Hong Kong is explored in this study.Objective: This study aims to describe the local practice of the use of ECMO in poisoning in Hong Kong.Method: This was a retrospective analysis of patients receiving ECMO for toxicological‐related causes between January 2013 and December 2023. Indications, the poisons of concern, and the mortality of the patients were reviewed.Results: We reported a total of 20 cases during the study period. Fourteen of them received VA‐ECMO, and six of them received VV‐ECMO. The most common poisons in patients receiving VA‐ECMO were calcium channel blockers and beta blockers. The ICU mortality rate for patients receiving VV‐ECMO was 16.6%, whereas it was 42.8% for those receiving VA‐ECMO. Of the 4 patients who received ECPR, the mortality rate was 75%. Most of the patients who survived had excellent cerebral performance category at 3 months.Conclusion: ECMO might be a useful modality for providing temporary respiratory and circulatory support to poisoned patients.

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