(895) Assessing Utilization of Plasma Exchange in ECMO for Calcium Channel Blocker Ingestions

Introduction: Ingestion of cardiovascular medications in pediatric patients is an independent risk factor for requiring intensive care interventions (Simpson et al, 2023). In Simpson et. al, 4 of 5 patients that required ECMO support ingested calcium channel blockers (CCB). CCB are highly protein bound with a large volume of distribution making dialysis ineffective for drug removal. Ingestions of CCB can cause cardiovascular collapse, secondary to cardiac depression and vasoplegia refractory to medical management. A systematic review showed the average time on ECMO support for CCB ingestion in adults was 4.3 days (Finn et. al, 2024). The aim of this retrospective study is to assess the use of plasma exchange (PE) in pediatric patients requiring ECMO support after ingestion of CCB.

Methods: Review of ECMO data from Children’s Healthcare of Atlanta was completed from 2000 to 2024 to identify patients who required ECMO secondary to ingestions of CCB. Further delineation was completed to identify patients who received PE. Individual chart review was completed to obtain data.

Results: Seven patients were identified as requiring VA-ECMO for CCB ingestions, 5 patients received PE. Four patients (80%) who received PE survived to hospital discharge. Of patients who received PE, 1 ingested amlodipine and 4 were poly-ingestions with the most clinically significant symptoms from amlodipine. Ages ranged from 14 to 17 years old, median age being 16. Of the patients who received PE, all received high dose vasoactives (epinephrine, norepinephrine, vasopressin) and high dose insulin and glucagon therapy. Other therapies trialed for select patients pre-ECMO cannulation included calcium infusion (80%), methylene blue (60%), giapreza (40%), lipid sink (40%), and hydrocortisone (20%). All patients received 1 round of PE except for 1 patient who received 2 rounds. For the patients who received PE, median duration of VA-ECMO was 54 hours (range 33 hours to 80 hours) and median time to decannulation after PE was 40 hours (range 30 hours to 73.5 hours).

Conclusions: Data about ingestions and required support is difficult to analyze due to number of confounding variables, data from this patient cohort indicates PE may be associated with reduced duration of ECMO for CCB ingestions when compared to the average from adult studies.