招聘講演（17）

Great and recent experience of cardiotropic drug induced cardiovascular shock

Frédéric J Baud¹, Bruno Mégarbane¹, Nicolas Deye¹, Pascal Leprince², Alain Pavie²

¹Assistance Publique-Hôpitaux de Paris-Medical and Toxicological Critical Care Department-University Paris Diderot. 75010 Paris. France.

²Assistance Publique-Hôpitaux de Paris-Department of thoracic and cardiovascular surgery. University Paris 6. 75013 Paris. France.

Numerous substances including drugs, chemicals, and plants exhibit cardiovascular toxicity. These poisoning are rare. However, they account for a large number of deaths. There is no perspective to improve the treatment of toxicant-induced cardiovascular shock, except colchicine-specific Fab fragments. Since 2002, in attempt to improve the treatment of toxicant-induced cardiovascular failure, we have developed a program of clinical research including -1- Assessment of criteria for refractoriness to conventional treatment. Indeed, prognostic factors proved to be useful in a number of cardiotropic drug poisoning. However, new therapeutic perspectives including extracorporeal life support (ECLS) require clarifying prognosticators of death in patient receiving conventional treatment. -2- Rapid assessment of the primary mechanism of cardiovascular shock. Toxicant-induced shock may result from three mechanisms: hypovolemia, cardiac failure, and arterial vasodilation that are frequently combined, complicating the selection of efficient treatment. This issue can be addressed using easily collected parameters including non invasive and invasive measurements. -3- Owing to our ability to refine prognosticators of refractoriness to conventional treatment of poisonings involving membrane stabilizing agents (MSA) and calcium channel blockers (CCB), and to rapidly assess severity of cardiac failure in toxicant-induced cardiovascular shock, we have developed the use of ECLS. The survival rate of ECLS-treated poisonings is closely related to the condition of presentation: 10% (5/49) in refractory cardiac arrest, 57% (13/23) in cardiogenic shock. ECLS appears life-saving in poisonings involving MSA and promising in cardiotoxic CCB. The onset of ARDS while cardiac failure is improving is a major threat at the time of ECLS withdrawal.