Extracorporeal Membrane Oxygenation for Calcium Channel Blocker Intoxication: A Multicenter Retrospective Registry Review.

Abstract

Calcium channel blocker (CCB) toxicity can lead to cardiogenic shock and circulatory collapse. Extracorporeal membrane oxygenation (ECMO) has been used as salvage therapy when conventional treatments fail, but outcomes data-especially comparing pediatric and adult populations-are limited. We conducted a retrospective analysis of the Extracorporeal Life Support Organization (ELSO) registry from 2015 to 2023, identifying 157 patients aged greater than or equal to 28 days with CCB toxicity. The primary outcome was survival to discharge. Univariate logistic regression identified survival-associated factors. Overall survival was higher in pediatric patients, compared to adults (80% vs . 63%, p = 0.0536). Veno-arterial ECMO was used in 90% of cases. Extracorporeal membrane oxygenation use increased over time without a decrease in survival. Higher age (1 year increase: odds ratio [OR] = 0.97/year, 95% confidence interval [CI]: 0.95-0.99) and lower arterial pH (per 0.1 pH increase, OR = 1.39, 95% CI: 1.04-1.86) had lower unadjusted odds of survival. The presence of pre-ECMO cardiac arrest (OR = 0.29, 95% CI: 0.12-0.65) and use of extracorporeal cardiopulmonary resuscitation (CPR) (OR = 8.27, 95% CI: 1.91-57) had lower unadjusted odds of survival. Extracorporeal membrane oxygenation is increasingly used as a rescue therapy for severe CCB toxicity. Factors such as younger age, preserved pH, and absence of cardiac arrest before cannulation are associated with improved outcomes.