Efficacy of fresh frozen plasma transfusion in comparison with conventional regimen in organophosphate poisoning treatment: a meta-analysis study

Abstract

Objective

To evaluating the efficacy of fresh frozen plasma (FFP) in comparison with conventional regimen in the treatment of organophosphate (OP) poisoning.

Methods

PubMed, ScopeMed, Cochrane, Scopus, and Google Scholar databases were searched. The search strategy used the following key words “organophosphate” and “poisoning or toxicity”, “(atropine and oxime)”, “fresh frozen plasma”, “clinical trial”, “outcome”. The treatment with atropine or/and oxime was considered conventional therapy. The length of hospitalization, the length of ICU admission, need for mechanical ventilation and its duration, clinical recovery point, choline esterase level, mortality rate, and intermediate syndrome (IMS) occurrence were the key outcomes of interest. Databases were searched during the period of 2003–2019. Five studies were included in the analysis.

Results

Pooling of data showed that the relative risk (RR) of mortality in OP poisoning for five included trials comparing FFP-treated group with conventional regimen therapy was [0.563 (95% CI (0.252, 1.255)]. The summary of RR for IMS in two studies was [RR: 1.34, 95% CI (0.655, 2.742)]. In addition, there was a non-significant mean difference (MD) in hospital stay [MD: −0.106, 95% CI (−0.434, 0.223)] in three included trials. A significant MD was observed in the length of ICU admission in two trials between FFP-treated group compared to the conventional treatment group [MD: −2.672, 95% CI (−4.189, −1.154)], but after random effects meta-analysis, the changes were not significant [MD: −2.015, 95% CI (−6.308, 2.277)]. The summary of fixed-effect meta-analysis for choline esterase level in three trails was [MD: −0.117, 95% CI (−0.468, 0.234)]. The RR of ventilation requirement for two included trials in the FFP-treated group comparing to the conventional regimen therapy was [0.84, 95% CI (0.691, 1.022)] while for ventilation duration in two studies was [MD: −0.183, 95% CI (−0.567, 0.201)].

Conclusion

The addition of FFP to conventional therapy did not improve the outcomes of mortality, IMS, hospital length of stay, cholinesterase levels, need or duration of mechanical ventilation, and only the length of ICU stay could affect in the treated group.

Keywords:

• Organophosphate poisoning
• atropine
• oximes
• fresh frozen plasma
• clinical trials
• outcome

Acknowledgements

The authors acknowledge the advice of the editor gratefully and also the comments of the reviewer who was selected by the editor. They helped them to improve the quality of final version of the manuscript.

Author contributions

FGH and RM generated the idea and design of study. MAS and RN searched the literatures in databases, wrote some part of manuscript. AF and MRM participated in statistical analyses and edited result part. NEM, RM, FGH, GHD, and AW reviewed the manuscript. NEM and RM wrote the discussion section, and with AW and FGH, supervised all parts of revision part of manuscript. RM acted as the corresponding author.

Declaration of interest

The authors take complete accountability for the content of this paper. Affiliations for the authors have been inserted in the cover page. All authors have contributed to the preparation of this article. This paper has had a little financial support to be designed and provided. The authors declare no conflict of interest in this study.

Additional information

Funding

This work was supported by the Isfahan University of Medical Sciences, Isfahan Clinical Toxicology Research Center [Grant number 298166].