Poly-intoxication including cardiotoxic drugs with MSA, which is known to be associated with a high mortality rate [27], was involved in a majority of cases, as previously reported [28]. All patients were in prolonged cardiac arrest or refractory shock according to the definitions proposed by Baud and colleagues [28].ECLS feasibility and efficiencyWe confirmed the feasibility www.selleckchem.com/products/Cisplatin.html of emergency ECLS in accordance with previous reports focusing on prolonged cardiac arrest regardless of the cause [19,22]. The physiologic objective was to provide temporal circulatory support to the vital organs and unload the failing heart as the injured myocardium attempts to recover. In previous cohort studies [19,22], survival rates were clearly higher in the toxic cardiac arrest group, as compared with other causes of cardiac arrest (3 of 12 vs 0 of 5 [19] and 4 of 6 vs 4 of 34 [22], respectively).

The high survival rate (76%) reported in our cohort was in accordance with the general survival rate from 58% (15 of 26) in case reports of poisoned patients who benefited from ECLS [3-14,16,17,19]. The 5 of 7 (71%) survival rate we reported among patients with cardiac arrest was in contrast with the dramatically low survival rate of 7% and 4.5%, respectively, reported in overdoses involving cardiac arrest [29,30]. To our knowledge, no studies have reported the survival rate of patients with drug-induced cardiovascular shock apparently refractory to conventional treatment, limiting comparisons with our cohort. However, experimental studies with control groups demonstrated that ECLS improved survival in animal models of severe cardiotoxic drug-induced shock [31,32].

These results suggest that ECLS could be considered as a good emergency resuscitative tool in this setting.ECLS complicationsSevere cannulation-related limb ischemia was the major problem when we first started the technique. Therefore, to accomplish a perfusion of the distal limb, surgeries performed an additional arterial shunt with a small 8 F catheter between the side port of arterial cannula and a point located some centimeters distally in the superficial femoral artery shunt. After this supplementary shunt was added, only distal embolic ischemia were reported. In contrast to M��garbane and colleagues [19], the rate of cannulation-related complications, limb ischemia, and major bleeding was relatively high despite the modified Seldinger technique and additional distal limb perfusion.

These differences could be explained by a higher ECLS duration in our study. However, our results were in accordance with reports of significant morbidity associated with emergency Dacomitinib ECLS [33]. In addition, no death was induced by cannulation-related complications, and all survivors were discharged without significant cardiovascular or neurological sequelae.LimitationsFirstly, because ECLS indication for drug overdose is rare, the sample size is small.