FINANCIAL DISCLOSURE | CONTACT US

Copyright © 2019 || EXTRIP || All rights reserved |

  • Twitter
Background

The use of extracorporeal purification specifically for drug poisoning has existed in the clinical practice for over 70 years. Unfortunately, the evidence remains limited to reviews, opinions, commentaries, and case reports which are susceptible to biases and confounders. Randomized trials and comprehensive systematic reviews are inexistent. Furthermore, the toxicokinetic measurements and calculations in published reports are often imprecise, incomplete or incorrect; this limits the interpretation of the effect of extracorporeal treatments (ECTRs).

 

Despite the increasing use of ECTRs (including hemodialysis, hemofiltration, hemoperfusion, peritoneal dialysis, therapeutic plasma exchange, and exchange transfusion) in poisoning, clinicians remain uncertain of their precise role in poisoning, because of the following points:

 

  • Despite the improvement in understanding drug pharmacokinetics, recurrent errors are still perpetuated in evaluating dialyzability of some poisons.

  • The development of new antidotes and perfection of supportive care have forced the re-evaluation of ECTRs in certain poisonings.

  • New ECTRs are being invented while others are hybridized or falling out of use. ECTR technology is constantly evolving, making past conclusions sometimes inapplicable today. Physicians are not always knowledgeable on the intricacies of all available ECTRs and which are best suited for a specific poisoning. 

  • Dialyzability and clinical improvement do not always correlate.

  • Because of the historical use of ECTR, ethics review boards would likely never sign off on a trial comparing ECTR to placebo (in salicylate poisoning for example). This absence of robust evidence and unlikelihood that this would ever be obtained may lure clinicians to conclude that ECTR is not an essential arsenal in the treatment of a poisoned patient, even if a majority of experts would recommend its use.

 
Objectives

  • To perform systematic reviews on the use of ECTRs in various poisonings. The literature search will not be limited by date of publication or language. 

  • To provide clinical recommendations on the use of ECTRs in poisoning, including criteria for indication, cessation, and choice of ECTR. The process will strive to be reproducible, robust, consistent, and transparent, according to the most rigorous methodology for guideline publication.

  • To publish guidelines for prospective data collection, calculations, and data reporting to assist clinicians, authors and reviewers.

  • To offer tools and collaboration for multicentric research opportunities.