Lipid rescue therapy and ECMO in the poisoned patient — can they be used together?

3 out of 5 stars What are the adverse effects associated with the combined use of intravenous lipid emulsion and extracorporeal membrane oxygenation in the poisoned patient? Lee HM et al. Clin Toxicol 2015;53:145-150. Abstract Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is often used in the neonatal and pediatric intensive care units on children who are also receiving intravenous lipid emulsion (LE) for nutritional support. Complications reported in patients receiving both interventions include lipid agglutination, clogging, occurrence of blood clots, and cracking of parts of the ECMO circuit. There is increasing interest in treating critically ill poisoned patients with VA-ECMO to support failing cardiac and pulmonary function. The idea is that this support will be a “bridge to recovery” until the body can eliminate the poison or poisons impairing key organs. In toxicology cases, ECMO is still considered a “last-ditch” effort in patients who have failed standard therapy, often including lipid rescue therapy. Will toxicology patients develop the same complications seen in the pediatric population receiving both VA-ECMO and nutritional support with LE? This paper shows that the data is scarce. The authors did a literature search and found reports of 9 overdose patients treated with both LE and VA-ECMO. In 2 reports, it was specifically stated that no complications were observed. In 7 reports, the presence or absence of complications was...
Source: The Poison Review - Category: Toxicology Authors: Tags: Medical antidote ECMO extracorporeal membrane oxygenation intralipid lipid emulsion lipid rescue therapy poisoned patient Source Type: news