Hemoperfusion for Clinically Suspected Organophosphate and Carbamate Poisoning in Critically Ill Patients: A Randomized Trial

Critical Care Nephrology – Research Article

Omar S.a· Sooka P.N.a· Khoza S.b· Van Rooyen M.C.a· Mashamba L.a· Madi S.a· Mathivha L.R.a· George J.A.b

Author affiliations

aCritical Care, School of Clinical Medicine/University of Witwatersrand/Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
bChemical Pathology, School of Pathology/ University of Witwatersrand/ Charlotte Maxeke Johannesburg Academic Hospital, National Health Laboratory Service, Johannesburg, South Africa

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Article / Publication Details

First-Page Preview

Abstract of Critical Care Nephrology – Research Article

Received: January 28, 2022
Accepted: June 27, 2022
Published online: December 06, 2022

Number of Print Pages: 9
Number of Figures: 2
Number of Tables: 6

ISSN: 0253-5068 (Print)
eISSN: 1421-9735 (Online)

For additional information: https://www.karger.com/BPU

Abstract

Introduction: Organophosphate poisoning occurs frequently, and despite treatment, increased severity and intensive care unit (ICU) admissions have been observed. We hypothesized that early hemoperfusion/hemadsorption (HA) therapy would change the clinical course of the disease. Methods: We performed a prospective, open, randomized controlled study at an academic ICU. Adult patients referred for an acute cholinergic toxidrome were screened. Patients meeting inclusion and exclusion criteria were randomized to standard of care (SoC) or HA therapy plus SoC, which included 2 6-h cycles of HA 12 h apart beginning within the first 24 h of ICU admission. The primary outcome was a comparison of ICU length of stay (LOS). Results: There were no significant baseline differences between the groups. The median ICU LOS was 6.5 days (IQR 4.5–10) in the HA group compared to 8 days (IQR 3.5–17) for the control group, p = 0.58. Among patients with an excess ICU LOS ≥7 days, the median ICU LOS was significantly shorter for the HA group, 10 days (IQR 8–12) compared to 17 days (IQR 14–22) for the control group, p = 0.001, resulting in a cost saving of EUR 7308 per patient. Duration (8 days vs. 13.5 days) and cumulative dosage (316 mg vs. 887 mg) of atropine among patients with excess ICU LOS were significantly lower in the HA group compared to the SoC group, respectively. A similar reduction in the duration of mechanical ventilation (HA = 6 days vs. SoC = 15 days, p = 0.001) was found. The combination of day 28 mortality and severe complications was lower in the HA group (10%, n = 2/20) compared to the SoC group (42%, 14/33) p = 0.01. Conclusion: HA therapy resulted in significant cost savings driven by a reduced LOS among patients with excess ICU LOS ≥7 days. This therapy was also associated with a significant reduction in the combination of day 28 mortality and severe complications including cardiac arrest, organ dysfunction, reintubation, and tracheostomy.

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References Eddleston M. Novel clinical toxicology and pharmacology of organophosphorus insecticide self-poisoning. Annu Rev Pharmacol Toxicol. 2019 Jan 6;59:341–60. World Health Organisation. Safer access to pesticides for suicide prevention. Experiences from community interventions [Internet]. 2016 [cited 2021 Dec 11]. Available from: https://apps.who.int/iris/bitstream/handle/10665/246233/WHO-MSD-MER-16.3-eng.pdf;jsessionid=52FB78D354C742F4FC0D8E4EA66CAA8C?sequence=1. Eddleston M, Phillips MR. Self poisoning with pesticides. BMJ. 2004 Jan 3;328(7430):42–4. Bajracharya SR, Prasad PN, Ghimire R. Management of organophosphorus poisoning. J Nepal Health Res Counc. 2016 Sep;14(34):131–8. Peter JV, Moran JL, Graham PL. Advances in the management of organophosphate poisoning. Expert Opin Pharmacother. 2007 Jul;8(10):1451–64. Rother HA. Improving poisoning diagnosis and surveillance of street pesticides. S Afr Med J. 2012 Mar 23;102(6):485–8. Omar S, Bahemia IA, Toerien L, San Pedro KM, Khan AB. A retrospective comparison of the burden of organophosphate poisoning to an intensive care unit in Soweto over two separate periods. Afr J Emerg Med. 2021 Mar 1;11(1):118–22. African COVID-19 critical care outcomes study (ACCCOS) Investigators. Patient care and clinical outcomes for patients with COVID-19 infection admitted to African high-care or intensive care units (ACCCOS): a multicentre, prospective, observational cohort study. Lancet Lond Engl. 2021 May 22;397(10288):1885–94. Hazardous poisons taken off the shelf. Mail and Guardian [Internet]; 2011 [cited 2021 Nov 12]. Available from: https://mg.co.za/article/2011-05-20-hazardous-poisons-taken-off-the-shelf/. Li Z, Wang G, Zhen G, Zhang Y, Liu J, Liu S. Application of hemoperfusion in severe acute organophosphorus pesticide poisoning. Turk J Med Sci. 2017 Aug 23;47(4):1277–81. Okonek S, Tönnis J, Baldamus CA, Hofmann A. Hemoperfusion versus hemodialysis in the management of patients severely poisoned by organophosphorus insecticides and bipyridyl herbicides. Artif Organs. 1979 Nov;3(4):341–5. Bo L. Therapeutic efficacies of different hemoperfusion frequencies in patients with organophosphate poisoning. Eur Rev Med Pharmacol Sci. 2014;18(22):3521–3. Indira M, Andrews MA, Rakesh TP. Incidence, predictors, and outcome of intermediate syndrome in cholinergic insecticide poisoning: a prospective observational cohort study. Clin Toxicol Phila Pa. 2013 Nov;51(9):838–45. Senanayake N, Karalliedde L. Neurotoxic effects of organophosphorus insecticides. An intermediate syndrome. N Engl J Med. 1987 Mar 26;316(13):761–3. Umakanth M. Intermediate syndrome following organophosphate poisoning; review article. Asia Pac J Med Toxicol. 2019 Mar 1;8(1):19–24. Karalliedde L, Baker D, Marrs TC. Organophosphate-induced intermediate syndrome: aetiology and relationships with myopathy. Toxicol Rev. 2006;25(1):1–14. Peng A, Meng FQ, Sun LF, Ji ZS, Li YH. Therapeutic efficacy of charcoal hemoperfusion in patients with acute severe dichlorvos poisoning. Acta Pharmacol Sin. 2004 Jan;25(1):15–21. Mahomed S, Mahomed OH. Cost of intensive care services at a central hospital in South Africa. S Afr Med J. 2018 Dec 13;109(1):35–9. Martinez-Chuecos J, del Carmen Jurado M, Paz Gimenez M, Martinez D, Menendez M. Experience with hemoperfusion for organophosphate poisoning. Crit Care Med. 1992 Nov;20(11):1538–43. Kang EJ, Seok SJ, Lee KH, Gil HW, Yang JO, Lee EY, et al. Factors for determining survival in acute organophosphate poisoning. Korean J Intern Med. 2009 Dec;24(4):362–7. Hu SL, Wang D, Jiang H, Lei QF, Zhu XH, Cheng JZ. Therapeutic effectiveness of sustained low-efficiency hemodialysis plus hemoperfusion and continuous hemofiltration plus hemoperfusion for acute severe organophosphate poisoning. Artif Organs. 2014 Feb;38(2):121–4. Altintop L, Aygun D, Sahin H, Doganay Z, Guven H, Bek Y, et al. In acute organophosphate poisoning, the efficacy of hemoperfusion on clinical status and mortality. J Intensive Care Med. 2005 Nov–Dec;20(6):346–50. Guo L, Ye H, Pan L, Sun L, Ying B. [Clinical effect of hemoperfusion combined with hemodialysis in treatment of severe organophosphate pesticide poisoning]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi Zhonghua Laodong Weisheng Zhiyebing Zazhi Chin J Ind Hyg Occup Dis. 2014 Dec;32(12):928–30. Liang MJ, Zhang Y. Clinical analysis of penehyclidine hydrochloride combined with hemoperfusion in the treatment of acute severe organophosphorus pesticide poisoning. Genet Mol Res GMR. 2015 May 11;14(2):4914–9. Gil HW, Kim SJ, Yang JO, Lee EY, Hong SY. Clinical outcome of hemoperfusion in poisoned patients. Blood Purif. 2010;30(2):84–8. Dong H, Weng YB, Zhen GS, Li FJ, Jin AC, Liu J. Clinical emergency treatment of 68 critical patients with severe organophosphorus poisoning and prognosis analysis after rescue. Medicine. 2017 Jun 23;96(25):e7237. Biccard BM, Madiba TE, Kluyts H-L, Munlemvo DM, Madzimbamuto FD, Basenero A, et al. Perioperative patient outcomes in the African Surgical Outcomes Study: a 7-day prospective observational cohort study. Lancet Lond Engl. 2018 Apr 21;391(10130):1589–98. Biccard BM, Madiba TE, Surgical Outcomes Study investigators OSA. The South African Surgical Outcomes Study: a 7-day prospective observational cohort study. S Afr Med J. 2015 Sep 18;105(6):465–75. Article / Publication Details

First-Page Preview

Abstract of Critical Care Nephrology – Research Article

Received: January 28, 2022
Accepted: June 27, 2022
Published online: December 06, 2022

Number of Print Pages: 9
Number of Figures: 2
Number of Tables: 6

ISSN: 0253-5068 (Print)
eISSN: 1421-9735 (Online)

For additional information: https://www.karger.com/BPU

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