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Treatment of poisoning induced cardiac impairment using cardiopulmonary bypass: a review

¹ Department of Biosurgery and Surgical Technology, Imperial College, St Mary’s Hospital, London, UK
² Academic Department of Accident and Emergency Medicine, St Mary’s Hospital, London, UK
³ Cardiothoracic Surgery Department, St Mary’s Hospital, London, UK

Correspondence to:
Correspondence to:
Mr T Athanasiou
Department of Biosurgery and Surgical Technology, Imperial College, 10th Floor, QEQM Building, St Mary’s Hospital, London W2 1NY, UK; TAthan5253{at}aol.com

ABSTRACT
Severe poisoning can cause potentially fatal cardiac depression. Cardiopulmonary bypass (CPB) can support the depressed myocardium, but there are no clear indications or guidelines available on its use in severe poisoning. A review was conducted of relevant papers in the available literature (seven single case reports of both deliberate and accidental ingestion of cardiotoxic drugs and two animal studies). Although CPB is rarely used in the management of poisoning, it may have potential benefits for haemodynamic instability not responding to conventional measures. At present there is insufficient evidence concerning the use of CPB as a treatment for severe cardiac impairment due to poisoning (grade C). This review suggests that in patients with severe and potentially prolonged reversible cardiotoxicity there is potential for full survival with CPB, provided that the patient has not already sustained hypoxic cerebral damage due to resistant hypotension prior to its use.

Abbreviations: CPB, cardiopulmonary bypass; CPR, cardiopulmonary resuscitation; ECMO, extracorporeal membrane oxygenation

Keywords: cardiopulmonary bypass; poisoning; cardiotoxicity; overdose

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