Table 1.

Case Series of ECPR for Poisoning-Induced Cardiac Arrest.

#	Year	Author, country Hospital of interest	Study Type Language	Sample	Study period	Size	Key findings
9	2000	Massetti, FRA Caen University Hospital	Letter to the Editor English	Cardiopulmonary bypass for severe drug intoxication	N.A.	7	5/7 survival •1 survivor required fasciotomy for lower leg compartment syndrome
10	2001	Babatasi, FRA Caen University Hospital	Cohort French	ECLS for cardiac arrest following ingestion of cardiotoxic drugs	May 1997 – Mar 2000	6	4/6 survival •First 2 patients died of multiorgan failure following delays in time to ECPR •All survivors had no sequelae
11	2005	Massetti, FRA Caen University Hospital	Cohort English	ECLS for refractory cardiac arrest	Jun 1997 – Jan 2003	6	4/6 survival in “medical intoxication” group •Higher survival compared to non-poisoning arrests (4/34; 11.8%)
12	2007	Megarbane, FRA Lariboisiere Hospital	Cohort English	ECLS for refractory cardiac arrest	Jul 2003 – Jul 2005	12 •8 OHCA •4 IHCA	3/12 survival • All 3 survivors had neurologically-intact recovery o Flecainide/acebutolol: CPR duration 30min, left ICU Day 12 – despite markedly elevated plasma lactate of 39.0mmol/L before cannulation! o Acebutolol: CPR duration 100min, left ICU Day 13 o Acebutolol sustained-release: CPR duration 180min, left ICU Day 14 •CPR duration before ECLS initiation was long (120min, 45-180min) because cardiothoracic surgery was based at neighbouring hospital •Toxins: acebutolol (n=3), flecainide (n=2), chloroquine (n=2), verapamil (n=2), propranolol (n=1), dextropropoxyhen (n=1), colchicine (n=1) •Successful cannulation in all patients but failure to achieve targeted extracorporeal flow in 2/12 •Mean ECLS duration was 56 hours (5-108 hours) •Higher survival compared to non-poisoning arrests (0/5; 0.0%)
13	2007	Sodeck, AUT Vienna General Hospital	Case series English	Unstable bradycardia	Mar 1994 – Mar 2004	2	2/2 survival among intoxicated patients “stabilized only by cardiopulmonary bypass”
14	2009	Daubin, FRA Caen University Hospital	Cohort English	Drug-induced prolonged cardiac arrest/refractory shock	1997 – 2007	7	5/7 survival •All 5 survivors had neurologically-intact recovery (CPC 1)
15	2011	Masson, FRA Caen University Hospital	Comparative Cohort English	Persistent cardiac arrest /severe shock following drug intoxication	Jan 1999 – Jun 2010	3	3/3 survival
16	2015	Brunet, FRA Caen University Hospital	Cohort English	ECLS for refractory cardiac arrest/shock	Apr 2003 – Apr 2013	6 •2 OHCA •4 IHCA	4/6 survival •IHCA (3/4 survival) had more favourable outcomes to OHCA (1/2 survival) •Higher survival compared to arrests from acute coronary syndrome (2/12; 16.7%) or other causes e.g., drowning, pulmonary embolism (0/10; 0.0%)
17	2015	Rousse, FRA Lille University Hospital	Cohort English	ECLS in refractory OHCA	Dec 2009 – Dec 2013	9 •9 OHCA	0/9 survival •Median age 46.9years •All were witnessed arrests, no-flow duration <5min •4/9 had moderate-to-severe hypothermia (core T◦c <32◦c) but demised •Toxins: beta-blockers (n=2), calcium antagonists (n=1), SSRIs (n=2), benzodiazepines (n=2), poly-intoxication (n=2)
18	2015	Wang, USA ACMT ToxIC Registry	Cohort English	ECLS cases reported to ACMT ToxIC registry	Jan 2010 – Dec 2013	4	4/4 survival (See Table 1.1) •*Unclear if patients required ECPR to achieve sustained ROSC, or if ROSC was achieved with conventional CPR prior to ECMO initiation
19	2016	Baud, FRA Hospitals in Assistance Publique-Hopitaux de Paris (APHP) group	Cohort Spanish	ECLS for drug-induced refractory cardiogenic shock and cardiac arrest	2002-2012	71 •45 OHCA •26 IHCA	8/71 survival •5/45 (11.1%) for OHCA; 3/26 (11.5%) for IHCA •Dose ingested was “very high” in all cases • Higher survival in cardiotoxic (10%) vs non-cardiotoxic drug-induced arrests o Survival lowest for chloroquine, colchicine, verapamil o Survival poor for sedative/ hypnotic subgroup, suggesting arrest occurred because of anoxia o Survival highest for beta-blockers, antiarrhythmics
20	2017	Pozzi, FRA Louis Pradel Cardiogenic Hospital	Cohort English	ECLS for refractory cardiogenic shock/IHCA due to cardiotoxic poisoning	Jan 2010 – Dec 2015	3 •3 IHCA	1/3 survival •Only survivor had neurologically-intact recovery (CPC 1) •All intoxications were with beta-blockers, calcium channel blockers or membrane-stabilizing agents •All arrests were witnessed (no-flow time = 0 min) •Mean low-flow time was 67.5 min
21	2019	Lewis, USA California Poison Control System	Cohort English	ECLS cases reported to California Poison Control System	1997 – 2016	3	2/3 survival (See Table 1.1) •*Unclear if patients required ECPR to achieve sustained ROSC, or if ROSC was achieved with conventional CPR prior to ECMO initiation
22	2021	Pozzi, FRA Louis Pradel Cardiogenic Hospital	Cohort English	VA-ECMO for drug intoxication-induced refractory cardiogenic shock/cardiac arrest	Jan 2007 – Dec 2020	7 •1 OHCA •6 IHCA	3/7 survival •Significantly lower survival compared to 88.0% survival for ECLS for poisoning-induced cardiogenic shock
23	2022	Duburcq, FRA Lille University Hospital	Cohort English	VA-ECMO for drug intoxication	Jan 2014 – Dec 2020	12 •5 OHCA •7 IHCA	3/12 survival •All were witnessed arrests and received immediate CPR •IHCA (2/7 survival) had more favourable outcomes to OHCA (1/5 survival) •Initial rhythm was asystole in 11/12 •8 demised within 48h while on ECLS (multiorgan failure prompting withdrawal of ECLS, n=5; brain death, n=3); the last died after weaning off ECMO due to severe hypoxic ischemic encephalopathy •Low-flow duration shorter in survivors (45min (40-60)) than non-survivors (77.5min (65-100)) (p=0.02)