Role of ECMO in the Treatment of AIP

Aluminum phosphide (AlP) poisoning is a commonly reported toxicological emergency and is associated with a high mortality rate.Cardiotoxicity with persistent shock that does not respond to conventional management, arrhythmias, severe left ventricular dysfunction, inadequate tissue perfusion, and metabolic acidosis leading to multiorgan failure is the typical course observed with severe poisoning.With most deaths in AlP poisoning reported to occur within the first 12-24 hours, the use of extracorporeal membrane oxygenation (ECMO) is increasingly being studied, as the cardiocirculatory impairment in AlP patients is shown to be reversible within a few days.Irrespective of the multiple factors in AlP-poisoned patients leading to refractory shock, venoarterial-ECMO can be effective in tiding over the short-term cardiocirculatory crisis and to allow time for recovery of native cardiac function.Venoarterial-ECMO has been successfully employed in scenarios of sepsis with cardiac depression, septic shock, cardiac trauma, anaphylaxis, drug toxicity, and thus, can be a useful "bridge-to-recovery" option in improving survival rates.A review of selected case reports and studies related to use of ECMO in AlP poisoning is presented along with a brief discussion on aspects related to patient selection, initiation, management, monitoring, and potential complications during management.Role of other management strategies that can complement ECMO in management of AlP poisoning have been briefly discussed, with specific focus on continuous renal replacement therapy.Current gaps in knowledge regarding the use of ECMO for management of AlP poisoning and other similar toxicological emergencies, along with the need for better-designed, multicentric, prospective trials have been emphasized.