Hazardous Chemical Emergencies and Poisonings

Henretig et al. describe the hospital-based management of acute poisonings. We would like to remind clinicians of the emerging role and efficacy of extracorporeal therapies in patients with life-threatening intoxications.

Whereas continuous venovenous hemofiltration therapy alone, or in combination with hemoperfusion, can reduce mortality and improve treatment efficiency in patients with cholinergic compound intoxications, as seen in cases of acute paraquat poisoning,1 extracorporeal membrane oxygenation (ECMO) is also considered to be a good salvage therapy in cases of acute poisoning,2 particularly in patients with resultant acute respiratory distress syndrome (as occurs in cases of volatile hydrocarbon poisoning3) and in those with refractory circulatory shock (as occurs in anticholinesterase intoxications4). Extracorporeal therapies are now available in many intensive care units around the world and should be considered as coadjuvant supportive measures in patients with life-threatening intoxications until full recovery is achieved with first-line therapies or antidotes.

Source: https://www.nejm.org/doi/full/10.1056/NEJMc1906853