Search
Intravenous lipid emulsion (ILE) is use as a therapy of last resort in refractory cardiovascular shock from toxicity of select agents (e.g. calcium channel blockers, beta blockers and select Na-channel blocking agents). There are number of case reports/series that showed positive cardiovascular/hemodynamic response after ILE, which are prone to publication bias. Results from limited number of human trials have shown mixed results.
A study reviewed fatal cases of poisoning that received ILE from the National Poison Data System to characterize the clinical response of ILE therapy.
Results
N=459 cases from 2010 to 2015.
Most common substance involved
|
| N (%) | Number with ROSC (%) |
| Ca-channel blockers | 183 (40) | 8 (4.4) |
| Beta blockers | 102 (22) | 5 (4.9) |
| Bupropion* | 53 (12) | 5 (9.4) |
| TCAs* | 48 (10) | 2 (4.2) |
| Citalopram/escitalopram | 36 (8) | 0 |
| Quetiapine | 26 (6) | 1 (3.8) |
| Flecainide | 21 (5) | 5 (23.8) |
| Local anesthetics – parenteral* | 8 (2) | 1 (12.5) |
*Use of ILE supported by Lipid work group
Response rate
- No response: 45%
- Unknown response: 38%
- Transient/minimal response: 7%
- ROSC: 7%
- Immediate worsening: 3%
Possible adverse reactions (n)
- ARDS: 39
- Lipemia: 3
- Failure of CRRT filter: 2
- Worsening/new seizure: 2
- Asystole immediately after administration: 2
- Fat embolism: 1
Conclusion
- The number of failed cases of ILE therapy outnumbers the published cases of ILE success.
- Currently, there is a lack of data that shows the efficacy of ILE therapy.