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

doi:10.5847/wjem.j.1920-8642.2022.070

Abstract

Abstract:

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.

Key words: Extracorporeal membrane oxygenation, Implementation, Cardiac medication, Overdose, Predicting factor

David Vandroux, Thomas Aujoulat, Bernard-Alex Gaüzère, Bérénice Puech, Bertrand Guihard, Olivier Martinet. Predicting factors for the need of extracorporeal membrane oxygenation for suicide attempts by cardiac medication: a single-center cohort study[J]. World Journal of Emergency Medicine, 2022, 13(4): 283-289.

Figures/Tables 3

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Table 1.

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Characteristics	Patients without ECLS (n = 39)	Patients on ECLS (n = 10)	P-value
Age, years	45 (35-57)	45 (27-54)	0.70
Male gender	16 (41)	2 (20)	0.33
SAPS II	35 (21-43)	73 (61-87)	< 0.001
SOFA at admission	4 (0-6)	10 (9-10)	< 0.001
Time between ingestion and admission, h	5 (3-8)	4 (3-7)	0.66
Time between first medical contact and admission, h	2 (1-4)	1.5 (1-3)	0.57
Systolic arterial pressure, mmHg First medical contact At admission in ICU	100 (83-120) 113 (98-125)	75 (64-98) 105 (83-108)	0.03 0.06
Diastolic arterial pressure, mmHg First medical contact At admission in ICU	60 (50-70) 61 (50-72)	47 (39-65) 62 (55-74)	0.12 0.69
Mean arterial pressure, mmHg First medical contact At admission in ICU	73 (60-85) 78 (66-91)	53 (46-72) 74 (68-85)	0.02 0.60
Pulse pressure, mmHg First medical contact At admission in ICU	40 (30-50) 49 (42-64)	28 (25-34) 36.5 (28-49)	0.02 0.02
Heart rate, beats/min First medical contact At admission in ICU	74 (60-85) 70 (60-93)	57 (48-66) 59 (46-69)	0.03 0.02
Central nervous system dysfunction at first medical contact	10 (26)	4 (40)	0.44
Laboratory finding at admission Lactate, mmol/L pH K⁺, mmol/L Creatinine, µmol/L Proteins, g/L AST, U/L ALT, U/L	2 (1.3-3.6) 7.35 (7.33-7.41) 3.9 (3.5-4.2) 72 (59-139) 66 (61-72) 23 (15-31) 17 (10-28)	5.85 (3.8-10.6) 7.30 (7.19-7.37) 3.3 (2.9-3.9) 113.5 (68-159) 53 (46-63) 36 (22-148) 29 (18-81)	0.04 0.20 0.09 0.40 0.01 0.04 0.05
LVEF, %	55 (50-60)	27.5 (11-44)	< 0.001
Mechanical ventilation	11 (28)	10 (100)	< 0.001
Renal replacement therapy	4 (10)	5 (50)	0.02
ICU length of stay, d	2 (2-3)	11 (6-18)	< 0.001
Mortality	0	3 (30)
New suicide attempts at 2 years	4 (10)	0