Extracorporeal life support (ECLS) has become a common technique for treating refractory
cardiogenic shock and
cardiac arrest induced by
drug overdose. The aim of this paper is to present our group's 10-year experience (2002-2012) using ECLS to treat drug-induced, refractory
cardiogenic shock and
cardiac arrest. We review 112 consecutive cases of acute
poisoning requiring arteriovenous ECLS. We provided ECLS with a Rotaflow pump (Jostra-Maquette). In 71 cases (63%) the patient presented with refractory
cardiac arrest; 41 (37%) presented with refractory
cardiogenic shock. The dose ingested was very high in all cases. Survival was strongly related to presentation (
cardiogenic shock vs
cardiac arrest) and the type of drug taken. Survival was highest after overdoses of β-blockers and
antiarrhythmic drugs and lowest after overdoses of
chloroquine,
colchicine, or
verapamil. Survival rates were very low in the subgroup of patients presenting with
cardiac arrest who had taken
hypnotics or
sedatives, suggesting that the heart stopped more because of
anoxia than because of a direct cardiotoxic effect. In contrast, in cardiotoxic drug-
induced cardiac arrest, the survival rate of 10% was significantly higher than the rate in non cardiotoxic arrests. Survival rates in drug-induced
cardiogenic shock ranged from 45% to 100%. We conclude that ECLS should be considered for the management of cardiotoxic
drug overdose. Close cardiovascular monitoring should be initiated if a patient has taken a particularly high dose of a cardiotoxic drug. Severe
cardiotoxicity is rare but life threatening. The use of ECLS in these cases should be based on clinical criteria. Early use of ECLS in drug-induced
cardiogenic shock significantly improves survival. Delays in applying ECLS in severe drug-induced
cardiotoxicity-diagnosed based on type of drug, dose, and hemodynamic effects-can lead to
cardiac arrest and a worse outcome.