Background: Calcium channel blocker (CCB) toxicity presents a significant mortality risk, highlighting the need for effective treatment strategies such as ECMO. This study analyzes ELSO registry data to determine the mortality rate in adults treated with ECMO for CCB toxicity and identifies clinical predictors of mortality.

Methods: A retrospective analysis of the ELSO registry from January 2016 to April 2023 was conducted, focusing on adults with CCB toxicity who received ECMO. Data collected included patient demographics, ECMO details, pre-ECMO clinical indicators, and in-hospital mortality. The analysis employed descriptive statistics to profile the patient population, with independent t-tests and chi-square tests comparing survivors to non-survivors. Logistic regression identified mortality predictors, integrating multiple imputation to remedy missing data, thus ensuring the analysis’s integrity.

Results: The study determined a 40.6% mortality rate among patients treated with ECMO for CCB toxicity. Significant predictors of mortality identified through logistic regression included severe metabolic acidosis (pH < 7.1), the need for renal replacement therapy prior to ECMO, and neurological complications. An inverse relationship between ECMO support duration and mortality was noted, potentially indicating bias from premature discontinuation in patients with poor prognoses. The analysis acknowledged limitations due to incomplete data, particularly regarding pre-ECMO cardiac arrest and elevated lactate levels, affecting the ability to establish these as definitive predictors of mortality.

Conclusion: The mortality rate for ECMO-treated CCB toxicity was 40.6%, with severe metabolic acidosis, pre-ECMO renal replacement therapy need, and neurological complications identified as key predictors of mortality. Data limitations affected the analysis of certain predictors.