Performance of extracorporeal membrane oxygenation in patients with fatal paraquat poisoning: grasp for straws?

doi:10.5847/wjem.j.1920-8642.2021.03.013

世界急诊医学杂志（英文） ›› 2021, Vol. 12 ›› Issue (3): 232-234.doi: 10.5847/wjem.j.1920-8642.2021.03.013

收稿日期:2020-12-18 接受日期:2021-03-16 出版日期:2021-06-01 发布日期:2021-05-31

Performance of extracorporeal membrane oxygenation in patients with fatal paraquat poisoning: grasp for straws?

Meng-xiao Feng^1,^2,³, Yuan-qiang Lu^1,^2,³()

¹ Department of Emergency Medicine, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
² Department of Geriatric Medicine, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
³ Zhejiang Provincial Key Laboratory for Diagnosis and Treatment of Aging and Physic-chemical Injury Diseases, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China

Received:2020-12-18 Accepted:2021-03-16 Online:2021-06-01 Published:2021-05-31
Contact: Yuan-qiang Lu E-mail:luyuanqiang@zju.edu.cn

摘要/Abstract

. [J]. 世界急诊医学杂志（英文）, 2021, 12(3): 232-234.

Meng-xiao Feng, Yuan-qiang Lu. Performance of extracorporeal membrane oxygenation in patients with fatal paraquat poisoning: grasp for straws?[J]. World Journal of Emergency Medicine, 2021, 12(3): 232-234.

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参考文献 9

1	Dinis-Oliveira RJ, Duarte JA, Sanchez-Navarro A, Remiao F, Bastos ML, Carvalho F. Paraquat poisonings: mechanisms of lung toxicity, clinical features, and treatment. Crit Rev Toxicol. 2008; 38(1):13-71. pmid: 18161502
2	Li C, Hu D, Xue W, Li X, Wang Z, Ai Z, et al. Treatment outcome of combined continuous venovenous hemofiltration and hemoperfusion in acute paraquat poisoning: a prospective controlled trial. Crit Care Med. 2018; 46(1):100-7.
3	Feng MX, Li YN, Ruan WS, Lu YQ. Predictive value of the maximum serum creatinine value and growth rate in acute paraquat poisoning patients. Sci Rep. 2018; 8(1):11587. doi: 10.1038/s41598-018-29800-0
4	Tang X, Sun B, He H, Li H, Hu B, Qiu Z, et al. Successful extracorporeal membrane oxygenation therapy as a bridge to sequential bilateral lung transplantation for a patient after severe paraquat poisoning. Clin Toxicol (Phila). 2015; 53(9):908-13. doi: 10.3109/15563650.2015.1082183
5	Bertram A, Haenel SS, Hadem J, Hoeper MM, Gottlieb J, Warnecke G, et al. Tissue concentration of paraquat on day 32 after intoxication and failed bridge to transplantation by extracorporeal membrane oxygenation therapy. BMC Pharmacol Toxicol. 2013; 14:45. doi: 10.1186/2050-6511-14-45
6	Cole JB, Olives TD, Ulici A, Litell JM, Bangh SA, Arens AM, et al. Extracorporeal membrane oxygenation for poisonings reported to U.S. poison centers from 2000 to 2018: an analysis of the national poison data system. Crit Care Med. 2020; 48(8):1111-9. doi: 10.1097/CCM.0000000000004401
7	Mohan B, Gupta V, Ralhan S, Gupta D, Puri S, Mahajan R, et al. Impact of extra-corporeal membrane oxygenation on outcome of aluminium phosphide poisoning complicated with myocardial dysfunction. Clin Toxicol (Phila). 2019; 57(11):1095-102. doi: 10.1080/15563650.2019.1584297
8	de Lange DW, Sikma MA, Meulenbelt J. Extracorporeal membrane oxygenation in the treatment of poisoned patients. Clin Toxicol (Phila). 2013; 51(5):385-93. doi: 10.3109/15563650.2013.800876 pmid: 23697460
9	Cypel M, Keshavjee S. Extracorporeal life support as a bridge to lung transplantation. Clin Chest Med. 2011; 32(2):245-51. doi: 10.1016/j.ccm.2011.02.005

Variables	Patient 1	Patient 2	Patient 3	Patient 4	Patient 5
Age (years)	15	14	45	25	33
Gender	Female	Female	Male	Female	Female
Ingestion amount (mL)	150	100	110	90	100
Poisoning to admission time (hours)	4	24	24	24	10
Hospital stays (hours)	58.0	79.0	72.5	365.5	298.0
CRRT/HP	HP	HP	HP+CRRT	CRRT	HP+CRRT
Clinical manifestations before ECMO
Dyspnea	No	Yes	Yes	Yes	Yes
SaO₂ (%)	97.8	60.5	88.1	92.0	70.0
Creatinine (μmol/L)	243	464	354	120	296
PaO₂ (mmHg)	112	33	53	60	37
pH	7.40	7.44	7.45	7.45	7.45
WBC (×10⁹/L)	16.6	9.2	33.9	6.7	16.6
APACHE II score	11	28	15	8	12
CT scanning	No abnormality	Bilateral pulmonary multiple patchy blur	Bilateral pulmonary interstitial fibrosis	Bilateral pulmonary multiple patchy shadows with partial consolidation; bilateral pleural effusion	Bilateral pulmonary diffuse patchy shadows
Indications of ECMO	Circulatory failure	Cardiopulmonary failure	Respiratory failure	Respiratory failure	Respiratory failure
ECMO characteristics
Poisoning to ECMO time (hours)	21	96	72	144	72
ECMO pattern	V-A	V-A	V-V	V-V	V-V
Bypass	LFA-LFV	RFA-LFV	RFV-RJV	RFV-RJV	RFV-RJV
ECMO complications	Hemorrhage at puncture point	Hemorrhagic shock	Oropharyngeal hemorrhage	No	Multiple organ hemorrhage
ECMO to death time (hours)	41.0	7.0	24.5	245.5	236.0
Death reasons	MOF	Hemorrhagic shock	MOF	Respiratory failure, giving up treatment	MOF, giving up treatment

Performance of extracorporeal membrane oxygenation in patients with fatal paraquat poisoning: grasp for straws?

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