5 L/m2 and vasopressor (norepinephrine and epinephrine) was used to maintain a mean blood pressure of at least 60 mmHg. An inotropic selleck inhibitor support was used even if systemic perfusion was adequately performed by ECLS to maintain a pulsatile flow through the native heart. The aim was to decompress the left heart and minimize stasis, therefore reducing the risk of intracardiac thrombosis. If necessary, to accomplish mechanical decompression of the left heart, an atrial balloon septostomy was performed. A femoral vein approach was used in which a transeptal puncture, followed by blade septostomy, was performed under combined radioscopy and echocardiographic guidance. Sequential balloon inflations were carried out to achieve left heart decompression, which was confirmed by echocardiography.
The ECLS was monitored by trained ICU personnel. A perfusionist was also available for occasional monitoring visits and emergencies. Echocardiography was used serially to assess progressive myocardial recovery and exclude intracardiac thrombosis or other abnormalities. All patients were mechanically ventilated with 5 to 6 mL/kg tidal volume and 8 to 10 cmH2O positive end-expiratory pressure, and continuous venovenous hemofiltration was used to treat acute renal failure and regulate the intravascular volume and overall fluid balance, if necessary.WeaningThe decision to discontinue ECLS support was based on evidence of multiorgan failure, overwhelming sepsis, or severe neurological injury.
Patients were weaned off ECLS if the left ventricular ejection fraction, assessed by echocardiography during a reduction of pump flow to 500 to 1000 mL/min, was stable (> 50%) without deterioration in hemodynamic status. During this period, anticoagulation was adapted to adequate values of ACT (250 to 300 seconds). If the patient’s cardiovascular status remained stable, ECLS was withdrawn by cardiac surgeons.Statistical analysisQuantitative and qualitative data are expressed as mean (�� standard deviation), or median (range) and percentage, respectively.ResultsPatients and drugsSeventeen patients (11 females, 6 males; mean age 39 �� 18 years) were treated with ECLS following drug intoxication. All patients, except two, had ingested cardiotoxic drugs, including 11 cases of drugs with MSA. The majority (12/17) of poisonings resulted from mixed poisonings involving a combination of cardiotoxic drugs, various psychotic drugs, and alcohol (Table (Table11).
Table Anacetrapib 1Patients and drugs usedBaseline characteristicsThe baseline characteristics of patients at the time of ECLS implantation are reported in Table Table2.2. All patients, except two, were comatose. The patients’ median SAPS II score was 69 (26 to 82) and median SOFA score was 13.5 (3 to 18). The ECLS setup was performed for 13 patients in the operating room, 3 in the intensive care unit, and 1 in the emergency department.