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Abstract
Extracorporeal treatments (ECTRs), such as hemodialysis and hemoperfusion, are used in poisoning despite a lack of controlled human trials demonstrating efficacy. To provide uniform recommendations, the EXTRIP group was formed as an international collaboration among recognized experts from nephrology, clinical toxicology, critical care, or pharmacology and supported by over 30 professional societies. For every poison, the clinical benefit of ECTR is weighed against associated complications, alternative therapies, and costs. Rigorous methodology, using the AGREE instrument, was developed and ratified. Methods rely on evidence appraisal and, in the absence of robust studies, on a thorough and transparent process of consensus statements. Twenty-four poisons were chosen according to their frequency, available evidence, and relevance. A systematic literature search was performed in order to retrieve all original publications regardless of language. Data were extracted on a standardized instrument. Quality of the evidence was assessed by GRADE as: High = A, Moderate = B, Low = C, Very Low = D. For every poison, dialyzability was assessed and clinical effect of ECTR summarized. All pertinent documents were submitted to the workgroup with a list of statements for vote (general statement, indications, timing, ECTR choice). A modified Delphi method with two voting rounds was used, between which deliberation was required. Each statement was voted on a Likert scale (1–9) to establish the strength of recommendation. This approach will permit the production of the first important practice guidelines on this topic.
Acknowlegments
We would like to acknowledge the tremendous work of our dedicated translators: Marcela Covica, Alexandra Angulo, Ania Gresziak, Samantha Challinor, Martine Blanchet, Gunel Alpman, Joshua Pepper, Lee Anderson, Andreas Betz, Tetsuya Yamada, Nathalie Eeckhout, Matthew Fisher, Ruth Morton, Denise Gemmellaro, Nadia Bracq, Olga Bogatova, Sana Ahmed, Christiane Frasca, Katalin Fenyvesi, Timothy Durgin, Helen Johnson, Martha Oswald, Ewa Brodziuk, David Young, Akiko Burns, Anna Lautzenheiser, Banumathy Sridharan, Charlotte Robert, Liliana Ionescu, Lucile Mckay, Vilma Etchart, Valentina Bartoli, Nathan Weatherdon, Marcia Neff, Margit Tischler, Sarah Michel, Simona Vairo, Mairi Arbuckle, Luc Ranger, Nerissa Lowe, Angelina White, Salih Topal, John Hartmann, Karine Mardini, Mahala Bartle Mathiassen, Anant Vipat, Gregory Shapiro, Hannele Marttila, Kapka Lazorova. We also acknowledge the important contribution from our librarians and secretarial aids: Marc Lamarre, David Soteros, Salih Topal, Henry Gaston.
Declaration of interests
KA: Advisory board (Merck); MG: Lecturer (Amgen Canada and Janssen-Ortho), advisory boards (Genzyme, Amgen Canada);RM: Consultative work (Baxter Healthcare), Travel costs unrelated to EXTRIP (Roche, Amgen); JK: Advisory board and grant (Fresenius Medical Care); DG: Consultant (Takeda), Honorarium (Genzyme); RM: Grant (Hospira); TB: Guest speaker (Gambro); KL: Stock (Amgen). The remaining authors declare that they have no competing interests.
Funding for EXTRIP was obtained from the industry. These contributions are unrestricted educational grants and are solely used to finance: retrieval and translation of publications travel expenses to EXTRIP meetings for every participant or costs related to venue or conference calls for EXTRIP meeting. Furthermore, the EXTRIP workgroup state that there is no members of the committee from industry, no honorarium offered to expert members, no industry input into scientific content, development, and publication, no industry presence at any meetings, no industry awareness or comment on the recommendations allowed and no honorarium to members of the Poison Panel or Executive committee for any role in the scientific appraisal or meeting organization process. EXTRIP members do not have direct financial relationship with the sponsors. All reimbursement claims require presentation of acceptable expenses invoices to Verdun Hospital Research Fund where financial contributions are deposited. Disclosure of competing interests of members is declared in every publication of EXTRIP. EXTRIP current sponsors are: Leo Pharma (40 000$) Janssen-Ortho (15 000$) Fresenius Canada (15 000$), Amgen Canada (10 000$) Servier (3000$).