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Volume  2 (2024)
Volume  1 (2023)
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VOLUME 1 , ISSUE 2 ( April-June, 2023 ) > List of Articles

RESEARCH ARTICLE

Venoarterial Extracorporeal Membrane Oxygenation for Cardiogenic Shock in Aluminum Phosphide Toxicity

Aarthi Chellappan, Prashant Vaijyanath, Gunaseelan Ramalingam, Ramesh Varadharajan, Thilagavathy Rajkamal, Rajkumar Nagarajan

Keywords : Aluminum phosphide, Cardiogenic shock, Extracorporeal membrane oxygenation, Mortality, Toxicity

Citation Information : Chellappan A, Vaijyanath P, Ramalingam G, Varadharajan R, Rajkamal T, Nagarajan R. Venoarterial Extracorporeal Membrane Oxygenation for Cardiogenic Shock in Aluminum Phosphide Toxicity. Indian J ECMO 2023; 1 (2):52-54.

DOI: 10.5005/jaypee-journals-11011-0013

License: CC BY-NC 4.0

Published Online: 23-08-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Abstract

Introduction: Aluminum phosphide (ALP) toxicity causes high mortality, often implicated for suicidal purposes since it has no specific antidote. Release of phosphine upon ingestion leads to refractory cardiogenic shock and multiorgan failure, which are the highest predictors of mortality. Compared with conventional treatment, extracorporeal membrane oxygenation (ECMO) plays a significant role in such unsolved problems. Materials and methods: Retrospective study of 9 cases from 2021 to 2022 with an undetermined number of tablets consumed. On examination, all patients had arrhythmias, hypotension, ejection fraction (EF 10–20%), and severe metabolic acidosis. We divided our patients into groups A and B based on the time taken for initiating ECMO. In group A (4 patients) VA-ECMO was initiated within 6 hours. Group B (5 patients) patients had a delay in arrival and the late decision worsened their condition and ECMO was initiated after 8 hours of ingestion. Conclusion: Early initiation of ECMO seems to improve survival rates in ALP toxicity.

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  1. Cherfurka W, Kashi KP, Bond EJ. Effect of phosphine on electron transport in mitochondria. Pestic Biochem Physiol 1976;6(1):65–84. DOI: 10.1016/0048-3575(76)90010-9.
  2. Mohan B, Singh B, Gupta V, et al. Outcome of patients supported by ECMO an observational study. Indian Heart J 2016; 68(3):295–301. DOI: 10.106/j.ihj.2016.03.024.
  3. Hassanian-Moghaddam H, Zamani N, Rahini M, et al. VA-ECMO for ALP poison. Basic Clinical Pharmacol Toxicol 2016;118(3):243–246. DOI: 10.1111/bcpt.12481.
  4. Hsu CH, Chi B-C, Liu M-Y, et al. Phosphine induced oxidative damage: role of glutathione. Toxicology 2002;179(1–2):1–8. DOI: 10.1016/s0300-483x(02)00246-9.
  5. Bishav Mohan, Myocardial dysfunction in aluminium phosphide toxicity. DOI: 10.1080/15563650.2019.1584297.
  6. Farahani MV, Soroosh D, Marashi SM. Thoughts on the current management of acute celphos toxicity. Indian J Crit Med 2016; 20(12):724–730. DOI: 10.4103/0972-5229.195712.
  7. Mehrpourx O, Jafarzadeh M, Abdollahi M. Systemic review of ALP poisoning. Arh Hig Rada Toksikol 2012;63:61–73. DOI: 10.2478/10004-1254-63-2012-2182.
  8. Sharma A, et al. ECMO for ALP toxicity. PMID:26299790.
  9. Bogle RG, Theron P, Brooks P, et al. Aluminium phosphide poisoning. Emergency Med J 2006;23(1):e3. DOI: 10.1136/emj.2004.015941.
  10. Saif Q, Ruhi K, Aparna S. Aluminium phosphide induced acute kidney injury. Egypt J Toxicity Med 2015;27:115–117. DOI: 10.4103/1110-7782.157999.
  11. Mohan B, Singh B, Gupta V. Prolonged ECMO support for drug toxicity and its outcome. Indian J 2016; 68(3):295–301. DOI: 10.1016/J.IHJ2016.03.024.
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