ArticleCritical care explorations2026
Integrated Use of Extracorporeal Membrane Oxygenation and Molecular Adsorbent Recirculating System for Refractory Cardiotoxic Ingestion: A Single-Center Case Series.
Article in Critical care explorations, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundCardiotoxic ingestions of calcium-channel blockers and beta-adrenergic antagonists are highly lethal, often causing refractory vasoplegic shock and noncardiogenic pulmonary edema. While venoarterial extracorporeal membrane oxygenation (ECMO) is a recognized rescue therapy for cardiogenic shock, the roles of venovenous ECMO and albumin dialysis-specifically the molecular adsorbent recirculating system (MARS)-as well as the effectiveness of linking patients to therapy through a coordinated referral process remain underexplored. CASE SUMMARY: We describe five consecutive patients with severe cardiotoxic ingestions managed via a regionally triggered transfer pathway. Patients presented with profound hypotension and respiratory failure despite standard therapies. All five patients received MARS for drug clearance and vasoplegia management; two required venovenous ECMO for refractory hypoxemia. One patient died due to profound myocardial poisoning; four survived to discharge. Complications included continuous renal replacement therapy filter clotting and catheter-associated thrombosis.
conclusionsA coordinated regional protocol enabling early access to ECMO and MARS is feasible in massive cardiotoxic ingestions.
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