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：

Export PDF Favorites Scan Get Citation

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

1.	張馭濤, 蔣紹鋒, 郎楠, 等. 2017-2021 年我國急性化學品中毒病例特征分析. 職業衛生與應急救援, 2023, 41(1): 43-48.
2.	Maier S, R?sner 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.	蘭超, 呂青. ECMO 救治急性重癥中毒患者的治療進展. 中國急救醫學, 2021, 41(7): 621-623.
6.	辛萌, 謝海秀, 杜中濤, 等. 體外膜肺氧合在中國急性中毒成人患者中的應用: 2017-2021 年體外生命支持登記的回顧性分析. 中華急診醫學雜志, 2022, 31(12): 1597-1602.
7.	中國醫師協會急診醫師分會, 中國毒理學會中毒與救治專業委員會. 急性中毒診斷與治療中國專家共識. 中華急診醫學雜志, 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.	葉銓秋, 陳曉燕, 魯玫, 等. VV-ECMO 救治急性氮氧化物中毒致重度 ARDS 1 例報道. 現代醫藥衛生, 2023, 39(5): 898-900.
14.	張政. 3 種刺激性氣體中毒臨床治療現狀. 錦州醫科大學學報, 2021, 42(5): 105-109.
15.	陸歡, 劉奇, 蘭超. ECMO 在氨氣中毒致急性呼吸衰竭患者中的應用. 中華危重病急救醫學, 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.	張云, 張晶, 高霏, 等. ECMO 在農藥中毒救治中的應用. 中國急救復蘇與災害醫學雜志, 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.	中國醫師協會急診醫師分會, 中國急診專科醫聯體, 中國醫師協會急救復蘇和災難醫學專業委員會, 等. 刺激性氣體中毒診治專家共識. 中華急診醫學雜志, 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.	急性一氧化碳中毒診治專家共識組. 急性一氧化碳中毒診治專家共識. 中華物理醫學與康復雜志, 2022, 44(6): 481-486.
22.	馬傳根, 趙冬梅, 趙景霞. 體外膜肺氧合治療重度一氧化碳中毒(附 6 例報告). 急診醫學, 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.	孫陽陽, 駱媛, 王永安. 細胞因子在百草枯中毒致肺纖維化中的作用研究進展. 中國藥理學與毒理學雜志, 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.	菅向東, 張忠臣. 急性中毒致多器官功能障礙與休克. 實用休克雜志(中英文), 2018, 2(4): 204-207.
27.	孫承業. 實用急性中毒全書. 2 版. 北京: 人民衛生出版社, 2020: 16.
28.	李榮凌, 周本宏. 秋水仙堿中毒死亡及致急性冠脈綜合征與中毒性心肌炎 1 例. 中國醫院藥學雜志, 2021, 41(4): 434-436.
29.	高三花, 王永田, 劉衛斌, 等. 營養心肌治療對急性有機磷農藥中毒并發中毒性心肌炎患者心肌保護作用的臨床觀察. 河北醫藥, 2017, 39(15): 2308-2310.
30.	王停停, 劉清岳, 孫甲君. 靜脈-動脈體外膜肺氧合救治敵敵畏中毒致難治性休克 3 例. 中華勞動衛生職業病雜志, 2023, 41(9): 688-692.
31.	張帥, 菅向東, 吳強, 等. 蓖麻子中毒致休克一例. 中華衛生應急電子雜志, 2016, 2(3): 194-194.
32.	梁曉. 氯丙嗪治療頑固性呃逆致休克 1 例. 臨床合理用藥雜志, 2012, 5(35): 46, 48.
33.	吳小偉, 田懿. 蜂毒中毒致過敏性休克死亡鑒定 1 例. 中國法醫學雜志, 2022, 37(2): 205, 208.
34.	董偉, 邢燕, 史長松. β內酰胺類抗菌藥物導致過敏性休克合并橫紋肌溶解綜合征 1 例. 中國醫藥, 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.	張云, 張晶, 高霏, 等. ECMO 在心血管藥物中毒救治中的應用. 臨床急診雜志, 2020, 21(10): 832-839.
41.	趙知文, 周江, 黃明菁, 等. 體外膜肺氧合救治烏頭堿中毒 1 例. 中國臨床案例成果數據庫, 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, 段穎杰, 李蓮葉, 等. 4 例重度嬰兒肉毒桿菌毒素中毒患兒的救治與護理. 中國急救復蘇與災害醫學雜志, 2022, 17(12): 1677-1680.
45.	黃韻清, 周玉淑, 劉仁術, 等. 現代急性中毒診斷治療學. 北京: 人民軍醫出版社, 2002: 66-69, 76-104.
46.	張茂, 徐杰豐. 關注特殊情況下心臟驟停的復蘇. 華西醫學, 2019, 34(11): 1211-1216.
47.	胡苗, 熊濱, 韓林, 等. 以心臟驟停為主要癥狀的致死性蘑菇中毒二例報告并文獻復習. 中國臨床新醫學, 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.
53.	孫承業. 毒物危害形勢及應對策略. 職業衛生與應急救援, 2023, 41(1): 2-3.
54.	袁媛, 何仟, 王丹, 等. 2004-2021 年我國急性職業中毒報告事件特征分析. 職業衛生與應急救援, 2023, 41(1): 37-42.
55.	崔曉磊, 高恒波, 姚冬奇, 等. 體外心肺復蘇在心肺復蘇中的應用——《成人體外膜氧合循環輔助專家共識》解讀. 臨床薈萃, 2019, 34(5): 455-457.

1. 張馭濤, 蔣紹鋒, 郎楠, 等. 2017-2021 年我國急性化學品中毒病例特征分析. 職業衛生與應急救援, 2023, 41(1): 43-48.
2. Maier S, R?sner 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. 蘭超, 呂青. ECMO 救治急性重癥中毒患者的治療進展. 中國急救醫學, 2021, 41(7): 621-623.
6. 辛萌, 謝海秀, 杜中濤, 等. 體外膜肺氧合在中國急性中毒成人患者中的應用: 2017-2021 年體外生命支持登記的回顧性分析. 中華急診醫學雜志, 2022, 31(12): 1597-1602.
7. 中國醫師協會急診醫師分會, 中國毒理學會中毒與救治專業委員會. 急性中毒診斷與治療中國專家共識. 中華急診醫學雜志, 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. 葉銓秋, 陳曉燕, 魯玫, 等. VV-ECMO 救治急性氮氧化物中毒致重度 ARDS 1 例報道. 現代醫藥衛生, 2023, 39(5): 898-900.
14. 張政. 3 種刺激性氣體中毒臨床治療現狀. 錦州醫科大學學報, 2021, 42(5): 105-109.
15. 陸歡, 劉奇, 蘭超. ECMO 在氨氣中毒致急性呼吸衰竭患者中的應用. 中華危重病急救醫學, 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. 張云, 張晶, 高霏, 等. ECMO 在農藥中毒救治中的應用. 中國急救復蘇與災害醫學雜志, 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. 中國醫師協會急診醫師分會, 中國急診專科醫聯體, 中國醫師協會急救復蘇和災難醫學專業委員會, 等. 刺激性氣體中毒診治專家共識. 中華急診醫學雜志, 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. 急性一氧化碳中毒診治專家共識組. 急性一氧化碳中毒診治專家共識. 中華物理醫學與康復雜志, 2022, 44(6): 481-486.
22. 馬傳根, 趙冬梅, 趙景霞. 體外膜肺氧合治療重度一氧化碳中毒(附 6 例報告). 急診醫學, 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. 孫陽陽, 駱媛, 王永安. 細胞因子在百草枯中毒致肺纖維化中的作用研究進展. 中國藥理學與毒理學雜志, 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. 菅向東, 張忠臣. 急性中毒致多器官功能障礙與休克. 實用休克雜志(中英文), 2018, 2(4): 204-207.
27. 孫承業. 實用急性中毒全書. 2 版. 北京: 人民衛生出版社, 2020: 16.
28. 李榮凌, 周本宏. 秋水仙堿中毒死亡及致急性冠脈綜合征與中毒性心肌炎 1 例. 中國醫院藥學雜志, 2021, 41(4): 434-436.
29. 高三花, 王永田, 劉衛斌, 等. 營養心肌治療對急性有機磷農藥中毒并發中毒性心肌炎患者心肌保護作用的臨床觀察. 河北醫藥, 2017, 39(15): 2308-2310.
30. 王停停, 劉清岳, 孫甲君. 靜脈-動脈體外膜肺氧合救治敵敵畏中毒致難治性休克 3 例. 中華勞動衛生職業病雜志, 2023, 41(9): 688-692.
31. 張帥, 菅向東, 吳強, 等. 蓖麻子中毒致休克一例. 中華衛生應急電子雜志, 2016, 2(3): 194-194.
32. 梁曉. 氯丙嗪治療頑固性呃逆致休克 1 例. 臨床合理用藥雜志, 2012, 5(35): 46, 48.
33. 吳小偉, 田懿. 蜂毒中毒致過敏性休克死亡鑒定 1 例. 中國法醫學雜志, 2022, 37(2): 205, 208.
34. 董偉, 邢燕, 史長松. β內酰胺類抗菌藥物導致過敏性休克合并橫紋肌溶解綜合征 1 例. 中國醫藥, 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. 張云, 張晶, 高霏, 等. ECMO 在心血管藥物中毒救治中的應用. 臨床急診雜志, 2020, 21(10): 832-839.
41. 趙知文, 周江, 黃明菁, 等. 體外膜肺氧合救治烏頭堿中毒 1 例. 中國臨床案例成果數據庫, 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, 段穎杰, 李蓮葉, 等. 4 例重度嬰兒肉毒桿菌毒素中毒患兒的救治與護理. 中國急救復蘇與災害醫學雜志, 2022, 17(12): 1677-1680.
45. 黃韻清, 周玉淑, 劉仁術, 等. 現代急性中毒診斷治療學. 北京: 人民軍醫出版社, 2002: 66-69, 76-104.
46. 張茂, 徐杰豐. 關注特殊情況下心臟驟停的復蘇. 華西醫學, 2019, 34(11): 1211-1216.
47. 胡苗, 熊濱, 韓林, 等. 以心臟驟停為主要癥狀的致死性蘑菇中毒二例報告并文獻復習. 中國臨床新醫學, 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.
53. 孫承業. 毒物危害形勢及應對策略. 職業衛生與應急救援, 2023, 41(1): 2-3.
54. 袁媛, 何仟, 王丹, 等. 2004-2021 年我國急性職業中毒報告事件特征分析. 職業衛生與應急救援, 2023, 41(1): 37-42.
55. 崔曉磊, 高恒波, 姚冬奇, 等. 體外心肺復蘇在心肺復蘇中的應用——《成人體外膜氧合循環輔助專家共識》解讀. 臨床薈萃, 2019, 34(5): 455-457.

Previous Article
Disaster vulnerability analysis of a tertiary hospital in southwest China
Next Article
Research progress of amanitin-containing mushroom poisoning

West China Medical Journal

Progress in the application of extracorporeal membrane oxygenation in acute poisoning

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content