Gastrointestinal decontamination using oil-based solutions in patients with acute aluminum phosphide poisoning: a systematic review and meta-analysis

Abstract

Some studies suggested that gastrointestinal (GIT) decontamination with oil may improve the prognosis of patients who ingested aluminum phosphide (AlP). The aim of this study is to compare the efficacy and safety of gastric lavage with oil-based solutions to any method of gastric decontamination not using oils in patients presenting with acute AlP poisoning. The literature was searched for English-published randomized controlled trials (RCTs) from inception to 16 September 2023. The searched electronic databases included MEDLINE/PubMed, Cochrane Library, Web of Science, Egyptian Knowledge Bank, Scopus, and Google Scholar. Data were extracted and pooled by calculating the risk ratio (RR) for categorical outcomes and standardized mean difference (SMD) for numerical outcomes, with 95% confidence intervals (CI). Seven RCTs were included. Paraffin oil was significantly associated with a lower risk of mortality (RR = 0.59 [95% CI: 0.45, 0.76], p < .001), intubation (RR = 0.59 [95% CI: 0.46, 0.76], p < .001) and vasopressor need (RR = 0.71 [95% CI: 0.56, 0.91], p = .006). Survival time was significantly prolonged with paraffin oil (SMD = 0.72 [95% CI: 0.32, 1.13], p < .001). Coconut oil was significantly associated with prolonged survival time (SMD = 0.83 [95% CI: 0.06, 1.59], p = .03) as well as decreased risk of requiring intubation (RR = 0.78 [95% CI: 0.62, 0.99], p = .04). Oil-based GIT decontamination using paraffin oil showed benefits over conventional lavage regarding the incidence of in-hospital mortality and endotracheal intubation, and survival time. Coconut oil showed some benefits in terms of the intubation incidence and survival time. Decontamination using paraffin oil is recommended. Future clinical trials are warranted with larger sample sizes and focusing on cost-benefit and safety.

Keywords:

• Aluminum phosphide
• clinical trial
• coconut oil
• paraffin oil
• mortality

Acknowledgments

The authors deeply appreciate the valuable comments of Dr. Roger McClellan, Editor-in-Chief, and the anonymous reviewers. Their feedback greatly improved the quality and completeness of the article. Our sincere thanks also go to the researchers whose valuable literature made this meta-analysis possible. The authors would also like to express their sincere gratitude to Professor Inas El-Mehallawi (Professor of Forensic Medicine & Clinical Toxicology, Faculty of Medicine, Tanta University), Professor Maha Ghanem (Professor of Forensic Medicine & Clinical Toxicology, Faculty of Medicine, Alexandria University), and Professor Sahar Eldakroory (Professor of Forensic Medicine & Clinical Toxicology, Faculty of Medicine, Mansoura University) for their enthusiastic support and valuable feedback on this research work.

Declaration of interest

No potential conflict of interest was reported by the author(s).

Data availability statement

The data that support the findings of this study are available from the corresponding author, [AAE], upon reasonable request.