UMEM Educational Pearls

Category: Toxicology

Title: Adverse Effects of Combined Lipid Emulsion + VA-ECMO in Poisoned Patients

Keywords: ECMO, fat emulsion, lipid, intralipid, poison, extracorporeal membrane oxygenation (PubMed Search)

Posted: 2/3/2015 by Bryan Hayes, PharmD (Emailed: 2/12/2015) (Updated: 2/12/2015)
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A new review summarized published adverse effects when IV lipid emulsion is used along with venous-arterial extracorporeal membrane oxygenation (VA-ECMO) in patients with cardiotoxic drug poisoning.

Not surprisingly, running fat through the ECMO circuit can cause some issues. Here's what's been published:

  • cracking of stopcocks
  • fat emulsion agglutination
  • clogging and associated malfunction of the membrane oxygenator
  • increased blood clot formation in the circuit

It's unclear how these findings should change management if using both treatment modalities, but at the very least, be aware that fat depostion in the VA-ECMO circuits and increased blood clot formation can occur.


Lee HM, et al. What are the adverse effects associated with the combined use of intravenous lipid emulsion and extracorporeal membrane oxygenation in the poisoned patient? Clin Toxicol. 2015 Jan 29. [Epub ahead of print, PMID 25634667]

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