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Review
. 2024 Oct 24:29:62.
doi: 10.4103/jrms.jrms_123_24. eCollection 2024.

Effect of extracorporeal membrane oxygenation on mortality rate of aluminum phosphate poisoning: A systematic review and meta-analysis

Mohammad Moshiri  1   2 , Gholamali Dorooshi  3 , Leila Etemad  4 , Awat Feizi  5 , Alireza Rahimi  6 , Farzad Gheshlaghi  3 , Arman Otroshi  3 , Shiva Samsamshariat  3 , Nastaran Eizadi-Mood  7
Affiliations
Review

Effect of extracorporeal membrane oxygenation on mortality rate of aluminum phosphate poisoning: A systematic review and meta-analysis

Mohammad Moshiri et al. J Res Med Sci. .

Abstract

Background: Aluminum phosphate (ALP) poisoning has a high mortality rate (MR) secondary to cardiogenic shock. Recently, extracorporeal membrane oxygenation (ECMO) showed a successful result in this issue. We conducted a systematic review and meta-analysis to compare the MR of patients with ALP poisoning who underwent ECMO versus those with conventional treatment.

Materials and methods: Two parallel databases' reviews were done to find the ECMO treatment-applied studies or conventional treatment-applied studies according to the PRISMA protocol. All studies in any languages and English conference abstracts were included for ECMO treatment-applied studies. Only English-language human observational studies, which reported MR, were included in conventional treatment-applied studies. All ETAS case reports were summarized and used as a newly generated cross-sectional study (NGCSS) for inclusion in the meta-analysis.

Results: Out of 167 and 1043 records, 17 case reports (24 cases), 3 cross-sectional studies, and 9 conventional treatment-applied studies were selected. In meta-analysis NGCSS applied as the fourth cross-sectional ECMO treatment-applied studies. The overall MR of ECMO-treated cases (23% [95% confidence interval (CI): 7%-39%]) was significantly less than conventionally treated cases (60% [95% CI: 39%-63%]; P < 0.001). In ECMO-treated cases, the weighted mean difference (WMD) for age, blood pH, ALP dose, hospitalization, ECMO lag time, and ECMO duration were not statistically significant between survived and nonsurvived cases. However, WMD of cardiac ejection fraction (4.6%; 95% CI: 2.76%-6.39%; P < 0.0001), exposure to hospitalization lag time (-2.05; 95% CI: -4.05-0.14 h; P = 0.06), and length of hospital stay (16; 95% CI: 12.0-20.5 days; P < 0.0001) between survived and nonsurvived ETC were significant.

Conclusion: ECMO reduced the MR of ALP-poisoned patients; however, it is a highly invasive and complicated procedure.

Keywords: Extracorporeal membrane oxygenation; meta-analysis; pesticide; poisoning; survival rate.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
PRISMA flowchart for selection of articles in the systematic review and meta-analysis. WOS: Web of science, ECMO: Extracorporeal membrane oxygenation, JBS: JBI’s score
Figure 2
Figure 2
Comparing the overall mortality rate of aluminum phosphate-poisoned cases who were treated with or without extracorporeal membrane oxygenation (yes or no, respectively). The funnel plot and slope of Egger’s test showed a publication bias. The trim-and-fill correction method could not change the results. ES: Effect size, CI: Confidence interval
Figure 3
Figure 3
Meta-analysis of the waited mean difference of age, blood pH, dose of ingested aluminum phosphate, extracorporeal membrane oxygenation (ECMO) duration, ejection fraction at admission, lag time before hospitalization, lag time from hospitalization to ECMO, and hospital stay on in survived and nonsurvived groups who underwent ECMO. ALP: Aluminum phosphate, ECMO: Extracorporeal membrane oxygenation, EF: Ejection fraction
See this image and copyright information in PMC

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