Predicting factors for the need of extracorporeal membrane oxygenation for suicide attempts by cardiac medication: a single-center cohort study

• Published in: World journal of emergency medicine Vol. 13; no. 4; pp. 283 - 289
• Main Authors: Vandroux, David, Aujoulat, Thomas, Gaüzère, Bernard-Alex, Puech, Bérénice, Guihard, Bertrand, Martinet, Olivier
• Format: Journal Article
• Language: English
• Published: China World Journal of Emergency Medicine 2022; UMR 1094 Neuro-épidémiologie Tropicale,University of Limoges,87042 Limoges,France%Intensive Care Unit,Félix Guyon Hospital,University Teaching Hospital of La Réunion,97400 Saint Denis,Reunion Island,France; Cardiosurgical Intensive Care Unit,Dupuytren Ⅱ Hospital,University Teaching Hospital of Limoges,87042 Limoges,France; Cardiovascular Anesthesia Department,Félix Guyon Hospital,University Teaching Hospital of La Réunion,97400 Saint Denis,Reunion Island,France%Intensive Care Unit,Félix Guyon Hospital,University Teaching Hospital of La Réunion,97400 Saint Denis,Reunion Island,France%Service d'Aide Médicale d'Urgence,Félix Guyon Hospital,University Teaching Hospital of La Réunion,97400 Saint Denis,Reunion Island,France; Intensive Care Unit,Félix Guyon Hospital,University Teaching Hospital of La Réunion,97400 Saint Denis,Reunion Island,France; Second Affiliated Hospital of Zhejiang University School of Medicine
• Subjects: Aldosterone; Analysis; Angiotensin; Calcium channels; Cardiovascular agents; Digoxin; Drugs; France; Health aspects; Heart; Heart beat; Indian Ocean; Life Sciences; Medical research; Medicine, Experimental; Mortality; Original; Overdose; Santé publique et épidémiologie; Suicidal behavior; Indian Ocean; France; Extracorporeal membrane oxygenation; Overdose; Cardiac medication; Predicting factor; Implementation
• ISSN: 1920-8642
• DOI: 10.5847/wjem.j.1920-8642.2022.070

BACKGROUND: Severe poisoning due to the overdosing of cardiac drugs can lead to cardiovascular failure. In order to decrease the mortality rate, the most severe patients should be transferred as quickly as possible to an extracorporeal membrane oxygenation (ECMO) center. However, the predictive factors showing the need for venous-arterial ECMO (VA-ECMO) had never been evaluated. METHODS: A retrospective, descriptive, and single-center cohort study. All consecutive patients admitted in the largest ICU of Reunion Island (Indian Ocean) between January 2013 and September 2018 for beta-blockers (BB), calcium channel blockers (CCB), renin-angiotensin-aldosterone system blockers, digoxin or anti-arrythmic intentional poisonings were included. ECMO implementation was the primary outcome. RESULTS: A total of 49 consecutive admissions were included. Ten patients had ECMO, 39 patients did not have ECMO. Three patients in ECMO group died, while no patients in the conventional group died. The most relevant ECMO-associated factors were pulse pressure and heart rate at first medical contact and pulse pressure, heart rate, arterial lactate concentration, liver enzymes and left ventricular ejection fraction (LVEF) at ICU-admission. Only pulse pressure at first medical contact and LVEF were significant after logistic regression. CONCLUSION: A transfer to an ECMO center should be considered for a pulse pressure < 35 mmHg at first medical contact or LVEF < 20% on admission to ICU. KEYWORDS: Extracorporeal membrane oxygenation; Implementation; Cardiac medication; Overdose; Predicting factor