Keywords : Cardiorespiratory failure
Evaluation of treatment outcomes in aluminum phosphide poisoning patients supported by extracorporeal membrane oxygenation
European Journal of Molecular & Clinical Medicine,
2022, Volume 9, Issue 2, Pages 2181-2189
Background: Aluminum phosphide (AlP) is a highly toxic poison which directly affects cardiovascular system and results in death. Thus, this study was performed with the aim to evaluate the effect of venoarterial extracorporeal membrane oxygenation (VA-ECMO) on treatment outcomes in these patients.
Materials and Methods: This was a prospective study carried out for a duration of two and a half years at a tertiary care hospital in Gujarat, India. The patients who were exposed to AlP poison and were classified as high risk based on presence of myocarditis, reduced left ventricular ejection fraction (LVEF) < 30% and severe metabolic acidosis were included in the study after receiving their written informed consent. VA-ECMO was performed in these patients using femoral-femoral route. Heparin was continuously infused intravenously. The patients were weaned off of ECMO when LVEF > 35% and acidosis resolved. The data was analysed using SPSS v 19.0. P < 0.05 was considered significant.
Results: A total of 124 patients were enrolled during the study duration. The mean age of the patients was 35.74 ± 6.83 years and majority were males (75%). The average time of reaching the hospital was 160.85 ± 21.75 minutes and the average time of putting the patient on ECMO was 206.85 ± 18.21 minutes. The ECMO initiation time reduced from 180 minutes to approximately 30 minutes with average time being 60 minutes. There was a significant reduction in serum lactate levels and increase in LVEF at 24 hours, which predicted better outcomes (P = 0.001). The average ECMO run was 76 hours. Out of 124 patients, 109 were successfully discharged, while 22 developed complications and 11 patients died while on ECMO. The time of initiation of ECMO treatment was key factor involved in predicting the outcome (P = 0.01). The most common complication was bleeding at cannula site which occurred in seven patients.
Conclusion: In conclusion, VA ECMO can be used as treatment modality to improve survival outcomes in the patients with AlP poisoning. It improves LVEF and metabolic acidosis. Time of initiation of therapy plays a crucial role as an outcome predictor.