[Extracorporeal life support for poisonings with cardiotoxicants]

Acute poisonings with cardiotoxicants are responsible of significant morbidity and incompressible mortality, mainly among youths. Their incidence is increasing. Death mainly results from cardiac failure refractory to pharmacological treatments as well as sudden cardiac arrest refractory to cardiopulmonary resuscitation. Determination of the exact mechanism of shock is essential to guide adequate treatments. Treatment is supportive including high-dosage catecholamines and may require antidotes. Administration of other inotropic agents (including glucagon, phosphodiesterase inhibitors, calcium salts, and euglycemic insulin) may be discussed, although their efficacy is still not clearly established. Extracorporeal life support allows organ perfusion until reversal of cardiac dysfunction and elimination of the toxicant. Several cases of survival using this exceptional technique were reported in the literature. Thus, based on these reports, extracorporeal life support has gained a recognized place in the therapeutic arsenal of acute poisonings.