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Mégarbane B, Andujar P, Dehahaye A, Résière D, Benyamina M, Goldgran-Tolédano D, Baud F | Authors |
Acute poisonings with membrane stabilising agents: analysis of the predictive parameters of non-responsiveness to conventional therapies. | Title |
XXIII International Congress of the EAPCCT, Rome, Italy, 20-23 May, 2003. In: J Toxicol Clin Toxicol 2003, 41/4, 553-4 | Source |
| Membrane stabilising agents, Risk assessment, Predictive toxicology | Index terms |
|
Objectives: Acute self-poisoning with membrane stabilizing agents (MSA) (chloroquine, flecainide, tricyclic
antidepressants, betablockers or cocaine) are rare but may lead to cardiac arrest or severe cardiovascular failure. Our
objective was to identify in the severe poisonings, the predictive factors for failure of usual medical therapies. Methods:
Retrospective study of patients admitted in our intensive care unit (ICU) during the last 5 years, in relation to severe
acute self-intoxication with MSA and who received cathecholamines. Results were expressed as median [extremes].
Comparisons between groups of dead and surviving patients were done using Chi-2 and MannWhitney tests.
Determination and validation (sensitivity and specificity) of the predictive criteria of death were calculated on this study
population. Results: 137 patients were included (34 years [1484], 95 F/42 H). 38/137 patients (28%) died, of whom 32within 72 h. 21% presented a pre-hospital cardiac arrest, which was persistent on hospital admission in 25% of the cases. During ICU stay, 12% of the patients presented an intra-hospital cardiac arrest.We considered these following
parameters as predictive of death in ICU, in case of ingestion of an intoxicant with MSA: 1)- persistent cardiac arrest on
admission or 2)- refractory shock (defined by the persistence of a systolic blood pressure <90mmHg, despite adequate
1,000mL fluid loading, 375 ml 8.4% bicarbonate infusion in <8 h and >3 mg/h adrenaline infusion), in relation with
cardiac failure (confirmed by echocardiography or right cardiac catheterization), in the presence of signs of respiratory
failure (PaO2/FiO2 > 150mmHg under controlled mechanical ventilation and adequate sedation) or renal failure
(diuresis <20 mL/h or serum creatinine concentration >120 µmol/l). Taken together, these criteria allowed us to
identify the patients who died in ICU with a sensitivity rate of 87% and a specificity rate of 97%. Conclusion: Death
following acute self-intoxication with SMA is high and difficult to prevent. Characterization of the predictive parameters
of resistance to the usual medical therapies should allow improvement of the strategies of symptomatic management and
resuscitation. It may promote consideration of exceptional therapies such as extra-corporeal cardiovascular assistance, in
experienced multidisciplinary centers. | Abstract |
| Conf. paper | Type |
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