[Severe intoxication with cardiotoxic drugs: value of emergency percutaneous cardiocirculatory assistance]

Acute severe self-administration of an overdose of betablockers, calcium antagonists or antiarrhythmic drugs is rare but carries a mortality of 10-15%. Between May 1997 and March 2000, 6 patients with an average age of 34 years (range 17-55 years) had a cardiac arrest on admission requiring emergency cardiac massage and emergency intubation with ventilatory assistance following massive ingestion of cardiotoxic drugs. Echocardiography confirmed complete biventricular akinesia. The surgical team implanted a cardiovascular assist device (ECMO: Extra Corporeal Membrane Oxygenation) by the femoral approach with pre-heparinated percutaneous cannula. The first two patients died of multi-organ failure due to a delay in the installation of the assistance. The 4 other patients survived without sequellae or recurrences. The average time on ECMO was 59.25 +/- 2 hours (range 48-71 hours). The early recognition of the indication for ECMO was one of the most important predictive factors for morbidity and mortality. The strategy of patient management should be determined in the emergency room: in cases of cardiocirculatory arrest resistant to symptomatic treatment (stomach washout, intravenous fluids, isoprenaline, inotropic agents) an echocardiogram should be obtained and the cardiac surgical team alerted to the problem. The introduction of pre-heparinated circuits, percutaneous cannula and peripheral shunts has widened the indications, efficacy (detoxification, restoration of peripheral tissue perfusion) and accessibility to this material, while limiting its duration. The collaboration of experienced multidisciplinary teams (emergency room staff, cardiologists, anaesthetists and surgeons) should optimise the timing of implantation and the monitoring of these systems and improve the results of resuscitation of these patients.