Extracorporeal treatment for poisoning to beta-adrenergic antagonists: systematic review and recommendations from the EXTRIP workgroup
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Published:2021-06-10
Issue:1
Volume:25
Page:
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ISSN:1364-8535
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Container-title:Critical Care
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language:en
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Short-container-title:Crit Care
Author:
Bouchard JoséeORCID, Shepherd Greene, Hoffman Robert S., Gosselin Sophie, Roberts Darren M., Li Yi, Nolin Thomas D., Lavergne Valéry, Ghannoum Marc, Bouchard Josée, Shepherd Greene, Hoffman Robert S., Gosselin Sophie, Roberts Darren M., Li Yi, Nolin Thomas D., Lavergne Valéry, Ghannoum Marc, Alhatali Badria, Anseeuw Kurt, Bird Steven, Berling Ingrid, Bunchman Timothy E, Calello Diane P, Chin Paul K, Doi Kent, Galvao Tais, Goldfarb David S, Hassanian-Moghaddam Hossein, Hoegberg Lotte CG, Kallab Siba, Kebede Sofia, Kielstein Jan T, Lewington Andrew, Macedo Etienne M, MacLaren Rob, Megarbane Bruno, Mowry James B, Nolin Thomas D, Ostermann Marlies E, Peng Ai, Roy Jean-Philippe, Vijayan Anitha, Walsh Steven J, Wong Anselm, Wood David M, Yates Christopher,
Abstract
Abstract
Background
β-adrenergic antagonists (BAAs) are used to treat cardiovascular disease such as ischemic heart disease, congestive heart failure, dysrhythmias, and hypertension. Poisoning from BAAs can lead to severe morbidity and mortality. We aimed to determine the utility of extracorporeal treatments (ECTRs) in BAAs poisoning.
Methods
We conducted systematic reviews of the literature, screened studies, extracted data, and summarized findings following published EXTRIP methods.
Results
A total of 76 studies (4 in vitro and 2 animal experiments, 1 pharmacokinetic simulation study, 37 pharmacokinetic studies on patients with end-stage kidney disease, and 32 case reports or case series) met inclusion criteria. Toxicokinetic or pharmacokinetic data were available on 334 patients (including 73 for atenolol, 54 for propranolol, and 17 for sotalol). For intermittent hemodialysis, atenolol, nadolol, practolol, and sotalol were assessed as dialyzable; acebutolol, bisoprolol, and metipranolol were assessed as moderately dialyzable; metoprolol and talinolol were considered slightly dialyzable; and betaxolol, carvedilol, labetalol, mepindolol, propranolol, and timolol were considered not dialyzable. Data were available for clinical analysis on 37 BAA poisoned patients (including 9 patients for atenolol, 9 for propranolol, and 9 for sotalol), and no reliable comparison between the ECTR cohort and historical controls treated with standard care alone could be performed. The EXTRIP workgroup recommends against using ECTR for patients severely poisoned with propranolol (strong recommendation, very low quality evidence). The workgroup offered no recommendation for ECTR in patients severely poisoned with atenolol or sotalol because of apparent balance of risks and benefits, except for impaired kidney function in which ECTR is suggested (weak recommendation, very low quality of evidence). Indications for ECTR in patients with impaired kidney function include refractory bradycardia and hypotension for atenolol or sotalol poisoning, and recurrent torsade de pointes for sotalol. Although other BAAs were considered dialyzable, clinical data were too limited to develop recommendations.
Conclusions
BAAs have different properties affecting their removal by ECTR. The EXTRIP workgroup assessed propranolol as non-dialyzable. Atenolol and sotalol were assessed as dialyzable in patients with kidney impairment, and the workgroup suggests ECTR in patients severely poisoned with these drugs when aforementioned indications are present.
Funder
Verdun Research Fund
Publisher
Springer Science and Business Media LLC
Subject
Critical Care and Intensive Care Medicine
Reference332 articles.
1. Rotella JA, Greene SL, Koutsogiannis Z, Graudins A, Hung Leang Y, Kuan K, et al. Treatment for beta-blocker poisoning: a systematic review. Clin Toxicol (Phila). 2020:1–41. 2. Ghannoum M, Nolin TD, Lavergne V, Hoffman RS. Blood purification in toxicology: nephrology’s ugly duckling. Adv Chronic Kidney Dis. 2011;18(3):160–6. 3. Lavergne V, Nolin TD, Hoffman RS, Robert D, Gosselin S, Goldfarb DS, et al. The EXTRIP (Extracorporeal Treatments In Poisoning) workgroup: Guideline methodology. Clin Toxicol. 2012;50:403–13. 4. Berling I, King JD, Shepherd G, Hoffman RS, Alhatali B, Lavergne V, et al. Extracorporeal Treatment for Chloroquine, Hydroxychloroquine, and Quinine Poisoning: Systematic Review and Recommendations from the EXTRIP Workgroup. J Am Soc Nephrol. 2020;31(10):2475–89. 5. Wong A, Hoffman RS, Walsh SJ, Roberts DM, Gosselin S, Bunchman TE, et al. Extracorporeal treatment for calcium channel blocker poisoning: systematic review and recommendations from the EXTRIP workgroup. Clin Toxicol (Phila). 2021:1–31.
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