Extracorporeal treatment for poisoning to beta-adrenergic antagonists: systematic review and recommendations from the EXTRIP workgroup

@article{Bouchard2021ExtracorporealTF,
  title={Extracorporeal treatment for poisoning to beta-adrenergic antagonists: systematic review and recommendations from the EXTRIP workgroup},
  author={Jos{\'e}e Bouchard and Greene Shepherd and Robert S. Hoffman and Sophie Gosselin and Darren M. Roberts and Yi Li and Thomas D. Nolin and Val{\'e}ry Lavergne and Marc Ghannoum and Jos{\'e}e Greene Robert S. Sophie Darren M. Yi Thomas D. Val Bouchard Shepherd Hoffman Gosselin Roberts Li Noli and Jos{\'e}e Bouchard and Greene Shepherd and Robert S. Hoffman and Sophie Gosselin and Darren M. Roberts and Yi Li and Thomas D. Nolin and Val{\'e}ry Lavergne and Marc Ghannoum and Badria Alhatali and Kurt Anseeuw and Steven R. Bird and Ingrid Berling and Timothy E Bunchman and Diane P. Calello and Paul K L Chin and Kent Doi and Ta{\'i}s Freire Galv{\~a}o and David S. Goldfarb and Hossein Hassanian‐Moghaddam and Lotte CG Hoegberg and Siba Kallab and Sofia Kebede and Jan T Kielstein and Andrew Lewington and Etienne Macedo and Robert MacLaren and Bruno M{\'e}garbane and James B Mowry and Thomas D. Nolin and Marlies Ostermann and Ai Peng and Jean-Philippe Roy and Anitha Vijayan and Steven J. Walsh and Anselm Wong and David M. Wood and Christopher Yates},
  journal={Critical Care},
  year={2021},
  volume={25}
}
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… 
1 Citations

References

SHOWING 1-10 OF 367 REFERENCES
Extracorporeal treatment for calcium channel blocker poisoning: systematic review and recommendations from the EXTRIP workgroup
TLDR
Both dialyzability and clinical data do not support a clinical benefit from ECTRs for CCB poisoning, and the EXTRIP workgroup recommends against using extracorporeal methods to enhance the elimination of amlodipine, diltiazem, and verapamil in patients with severe poisoning.
Extracorporeal Treatment for Chloroquine, Hydroxychloroquine, and Quinine Poisoning: Systematic Review and Recommendations from the EXTRIP Workgroup.
TLDR
Although hydroxychloroquine was assessed as being non-dialyzable, the clinical evidence was not sufficient to support a formal recommendation regarding the use of extracorporeal treatments for this drug, and the EXTRIP workgroup recommends against using extacorporeal methods to enhance elimination of these drugs in patients with severe chloroquine or quinine poisoning.
Successful treatment of a massive atenolol and nifedipine overdose with CVVHDF.
TLDR
The patient recovered completely after Continuous Veno-Venous Hemo-Dia-Filtration (CVVHDF); this treatment removed atenolol from blood, with predicted clearance levels, and the clearance kinetics were consistent with the expected clearance values.
Treatment for beta-blocker poisoning: a systematic review
TLDR
Evaluating the effects of treatments for beta-adrenoreceptor antagonist poisoning found that catecholamines, inotropes and vasopressors provided a survival benefit and improved haemodynamics, but it is unclear whether high-dose insulin euglycaemic therapyImproved haemodynamic response above catechlamines and other inotropic agents in humans.
Are vasopressors useful in toxin-induced cardiogenic shock?
TLDR
A systematic review of the literature to evaluate the effectiveness of vasopressors in improving hemodynamic function and survival in the treatment of toxin-induced cardiogenic shock found that human case reports and controlled animal experiments lead to different conclusions about vasopressing in TICS.
The EXTRIP (EXtracorporeal TReatments In Poisoning) workgroup: Guideline methodology
TLDR
Rigorous methodology, using the AGREE instrument, was developed and ratified, and will permit the production of the first important practice guidelines on this topic.
Zero-order metoprolol pharmacokinetics after therapeutic doses: severe toxicity and cardiogenic shock
TLDR
The time course of cardiac dysfunction was longer than acute overdose but consistent with prolonged zero order elimination of metoprolol, suggesting the patient was a poor CYP2D6 metaboliser.
Severe Atenolol and Diltiazem Overdose
TLDR
Oliguria, which has previously been reported in severe atenolol overdose, was successfully treated without hemodialysis by the addition of phenylephrine to aggressive therapy with pacing, inotropic, and pressor support.
β-Blocker Dialyzability in Maintenance Hemodialysis Patients: A Randomized Clinical Trial.
TLDR
Atenolol and metoprolol are extensively cleared by hemodialysis compared with the negligible dialytic clearance of carvedilol, and data indicate that bisoproll is also dialyzable.
Calcium channel antagonist and beta-blocker overdose: antidotes and adjunct therapies.
TLDR
Management of cardiovascular instability resulting from calcium channel antagonist (CCB) or beta-adrenergic receptor antagonist (BB) poisoning follows similar principles and high-dose insulin euglycaemia is commonly recommended as a first-line treatment in these poisonings, to improve myocardial contractility, and should be instituted early when myocardIAL dysfunction is suspected.
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