Extracorporeal Life Support: Indications and Use in Severely Poisoned Patients

The primary cause of death in patients with severe poisonings is cardiopulmonary failure. Meticulous supportive care remains the mainstay of treatment. However, early aggressive hemodynamic support with extracorporeal life support (ECLS) can be beneficial in patients with severe refractory toxin-induced shock. Although ECLS cannot neutralize toxins or facilitate poison removal, it can restore end-organ perfusion until elimination of the toxin and/or end-organ recovery occur. Preferentially, ECLS is used as a “bridge to recovery,” and as such, severe poisoning is perhaps one of the most ideal indications for its use. The aim of this article is to review the history of ECLS and provide an overview of basic physiologic principles, current techniques, indications, contraindications, complications, and its role in the treatment of the severely poisoned patient with refractory cardiovascular collapse.