Extracorporeal life support for severe drug-induced cardiotoxicity: a promising therapeutic choice

Drug-induced cardiovascular failure is an acute condition that is associated with significant healthcare consequences. Antidotes and supportive treatments are the initial measures to manage cardiotoxicity, but if severe drug-induced cardiotoxicity develops, usually as cardiovascular shock or cardiac arrest, then circulatory assistance may have an important role in the therapeutic algorithm. A number of circulatory assistance techniques have been increasingly employed to treat severe drug-induced cardiotoxicity. These include extracorporeal membrane oxygenation, intra-aortic balloon pumping and standard cardiopulmonary bypass. Recently, extracorporeal life support (ECLS) has been developed to provide percutaneous cardiopulmonary support peripherally without the need for sternotomy. ECLS can provide successful treatment of severe drug-induced cardiotoxicity in selected cases. This technique may be associated with complications of limb ischaemia, haemorrhage and embolism. An increased consideration of ECLS within the context of rigorous clinical studies and strong evidence can add to its future use for severe drug-induced cardiotoxicity.