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Efficacy and outcomes of lipid resuscitation on organophosphate poisoning patients: A systematic review and meta-analysis

  • Author Footnotes
    1 These authors contribute equally to this research.
    Shiyuan Yu
    Footnotes
    1 These authors contribute equally to this research.
    Affiliations
    Department of Emergency Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
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  • Author Footnotes
    1 These authors contribute equally to this research.
    Shanshan Yu
    Footnotes
    1 These authors contribute equally to this research.
    Affiliations
    Department of Emergency Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
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  • Author Footnotes
    1 These authors contribute equally to this research.
    Lili Zhang
    Footnotes
    1 These authors contribute equally to this research.
    Affiliations
    Department of Emergency Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
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  • Yanxia Gao
    Affiliations
    Department of Emergency Medicine, The First Affiliated hospital of Zhengzhou University, Zhengzhou, China
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  • Joseph Walline
    Affiliations
    Accident and Emergency Medicine Academic Unit, 2/F, Main Clinical Block and Trauma Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
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  • Xin Lu
    Affiliations
    Department of Emergency Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
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  • Yong Ma
    Affiliations
    Department of Emergency Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
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  • Huadong Zhu
    Affiliations
    Department of Emergency Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
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  • Xuezhong Yu
    Correspondence
    Corresponding authors at: Emergency Department of Peking Union Medical College Hospital, Beijing 100730, China.
    Affiliations
    Department of Emergency Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
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  • Yi Li
    Correspondence
    Corresponding authors at: Emergency Department of Peking Union Medical College Hospital, Beijing 100730, China.
    Affiliations
    Department of Emergency Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
    Search for articles by this author
  • Author Footnotes
    1 These authors contribute equally to this research.
Published:November 17, 2018DOI:https://doi.org/10.1016/j.ajem.2018.11.022

      Abstract

      Objective

      Organophosphate (OP) pesticides are still widely available in developing countries, leading to numerous accidental or suicidal poisonings every year. Lipid emulsion treatments are commonly used in resuscitating OP poisoning patients but few studies regarding their use have been reported. Our meta-analysis aimed to analyze the efficacy and outcomes of lipid resuscitation on OP poisoning patients.

      Methods

      A systematic search for associated studies was conducted in Pubmed, EMBASE, MEDLINE, the Cochrane Library and the Chinese National Knowledge Infrastructure. Collected data was pooled using Revman v5.3. Outcomes included prognosis (cured vs. mortality rates), hepatic function (serum ALT, AST, Total Bilirubin (TBIL) level), serum acetylcholinesterase (AchE) level and respiratory function (rate of respiratory muscular paralysis).

      Results

      Seven randomized controlled studies consisting of 630 patients meeting inclusion criteria were identified. Lipid emulsion helped to improve the cure rate [OR = 2.54, 95% CI (1.33, 4.86), p = 0.005] and lower the mortality rate [OR = 0.31, 95% CI (0.13, 0.74), p = 0.009]. Serum ALT, AST and TBIL in patients undergoing lipid resuscitation were lower than those in the control groups [ALT, SMD = −1.52, 95% CI (−2.64, 0.40), p = 0.008; AST, SMD = −1.66, 95% CI (−3.15, 0.16), p = 0.03; TBIL, SMD = −1.26, 95% CI (−2.32, 0.20), p = 0.02]. Serum AchE level were increased in patients treated with lipid emulsion [SMD = 2.15, 95% CI (1.60, 2.71), p < 0.00001]. Rate of respiratory muscular paralysis was lower in patients undergoing lipid resuscitation than those in the control groups [OR = 0.19, 95% CI (0.05, 0.71), p = 0.01].

      Conclusion

      Based on our meta-analysis of included RCT reports, lipid resuscitation seems likely to help improve prognosis and liver function of OP poisoning patients. However, larger multi-center RCTs are still recommended.

      Keywords

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