However, because usefulness of ECLS in this setting remains debatable [20], we believe this study adds important information neither about ECLS as a rescue therapy in patients with drug-induced cardiac arrest and refractory shock.ConclusionsBased on our experience, we consider ECLS as a last resort, efficient, and relatively safe therapeutic option in critically ill poisoned patients (i.e. cardiac arrest and refractory shock) who do not respond to conventional therapies, providing the cardiac surgeon with the means to rapidly intervene and control ECLS-related complications. However, because there is insufficient evidence concerning the use of ECLS as a treatment for severe cardiac impairment due to poisoning, further studies are needed to clarify criteria for unresponsiveness to conventional treatment and the indications of ECLS in this setting.
Key messages? Cardiovascular failure is the leading cause of death following a cardiotoxic drug overdose.? This report supports the hypothesis that ECLS may be considered as a last resort, efficient, and relatively safe therapeutic option in critically ill poisoned patients (i.e. cardiac arrest and refractory shock) who do not respond to conventional therapies.AbbreviationsACT: activated clotting time; CPC: cerebral performance class; ECLS: extra corporeal life support; MSA: membrane stabilizing activity; SAPS: Simplified Acute Physiology Score; SOFA: Sequential Organ Failure Assessment.Competing interestsThe authors declare that they have no competing interests.Authors’ contributionsCD and MB initiated the study, and the design.
CD and PC were involved in the interpretation of the results. CD wrote the manuscript, and PC helped to draft the manuscript. PL, CI, MT, OL, MB, CQ, MM, and PC contributed to the conception of the study and revision of the manuscript. All authors read and approved the final manuscript.Authors’ informationThe work has been presented in part at the annual congress of the Soci��t�� de GSK-3 R��animation de Langue Fran?aise (SRLF) held in January 2008, Paris, France.NotesSee related commentary by Ashrafian and Athanasiou, http://ccforum.com/content/13/5/187AcknowledgementsWe are indebted to Dr Jean-Jacques Parienti from Department of Biostatistics and Clinical Research, Caen University Hospital, France, for his critical review of the manuscript. We thank Madame Val��rie Valfong for her contribution to polishing the manuscript.
Sepsis affects 750,000 patients per year in the USA, killing 250,000 of these people. In the UK severe sepsis has a mortality rate of 45% [1-3] and despite putative therapeutic options including early goal-directed therapy [4] and activated protein C [5], outcome in septic patients has not vastly improved.