A patient with a severe drug overdose may benefit from extracorporeal life support (ECLS).


NOTE: Extracorporeal life support is different from extracorporeal toxin removal, which is used to remove the toxin from the patient. Both techniques can be used in the same patient.


Patient selection: severe drug intoxication, usually including one or more cardiotoxic drugs


Site requirement: health care team experienced in ECLS management


Indications for ECLS:

(1) refractory shock: shock not responding to optimal conventional treatment

(2) refractory cardiac arrest: absence of spontaneous circulation after continuous cardiopulmonary resuscitation for >= 45 minutes


Criteria for successful ECLS:

(1) flow rate > 2.5 L per minute (Duabin et al says "> 2.5 L per meter square" but all other references are to L/min).

(2) mean blood pressure > 60 mm Hg


Premature discontinuation for ECLS:

(1) overwhelming sepsis

(2) multiorgan failure

(3) severe neurological complications

(4) massive hemorrhage


Indications for weaning of ECLS after successful life support: Cardiovascular status stable with a left ventricular ejection fraction > 50% at reduced ECLS pump support


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