Pediatric ECMO for toxin exposure: A case report

Abstract

Introduction- Treatment of shock and refractory hypoxemia in acute paediatric poisonings can be really challenging. Aluminium Phosphide (ALP) poisoning is a common in Northern India and is associated with very high mortality rate owing to development of cardiac dysfunction, resistant shock, refractory hypoxemia and severe metabolic acidosis. It is proposed that extracorporeal membrane oxygenation (ECMO) can improve survival in patients with toxic exposures by providing cardiorespiratory support and giving time to the heart and lungs to recover by itself. Case Report- In this case series two cases of adolescent girls with ALP poisoning suffering from refractory cardiogenic shock, fatal arrhythmias and severe metabolic acidosis were treated with veno-arterial ECMO . Extracorporeal cardiopulmonary resuscitation (ECPR) was done in both the patients, and hemodynamics improved after the commencement of ECMO. Ischemic changes in the cannulated limb were seen in both the patients. In one patient myocardium recovered and patient was weaned off the ECMO on the fourth day, while in the second case, myocardium did not show any recovery after 56 hours on ECMO and parents decided to discharge the child against medical advice because of the ischemia of the cannulated limb and girl died after the discontinuation of ECMO. Conclusion- With this report, we would suggest that ECMO might be considered as a bridge to recovery to tide over the acute critical phase in ALP or any paediatric poisoning associated with intractable cardiorespiratory failure not responding to maximal intensive care therapy , keeping in mind the risk-benefit ratio .

Keywords

• aluminium phosphide
• extracorporeal membrane oxygenation
• poisoning
• refractory shock
• refractory hypoxemia
• metabolic acidosis