The EXTRIP (EXtracorporeal TReatments in Poisoning) workgroup: Guideline methodology

Valéry Lavergne, Thomas D. Nolin, Robert S. Hoffman, Darren Roberts, Sophie Gosselin, David S. Goldfarb, Jan T. Kielstein, Robert MacTier, Robert MacLaren, James B. Mowry, Timothy E. Bunchman, David Juurlink, Bruno Megarbane, Kurt Anseeuw, James F. Winchester, Paul I. Dargan, Kathleen D. Liu, Lotte C. Hoegberg, Yi Li, Diane P. CalelloEmmanuel A. Burdmann, Christopher Yates, Martin Laliberté, Brian Scott Decker, Carlos Augusto Mello-Da-Silva, Eric Lavonas, Marc Ghannoum

Research output: Contribution to journalReview article

64 Scopus citations

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 (19) to establish the strength of recommendation. This approach will permit the production of the first important practice guidelines on this topic.

Original languageEnglish (US)
Pages (from-to)403-413
Number of pages11
JournalClinical Toxicology
Volume50
Issue number5
DOIs
StatePublished - Jun 1 2012

Keywords

  • Extracorporeal treatments
  • EXTRIP
  • Hemodialysis
  • Hemoperfusion
  • Intoxication
  • Overdose
  • Poisoning

ASJC Scopus subject areas

  • Toxicology

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    Lavergne, V., Nolin, T. D., Hoffman, R. S., Roberts, D., Gosselin, S., Goldfarb, D. S., Kielstein, J. T., MacTier, R., MacLaren, R., Mowry, J. B., Bunchman, T. E., Juurlink, D., Megarbane, B., Anseeuw, K., Winchester, J. F., Dargan, P. I., Liu, K. D., Hoegberg, L. C., Li, Y., ... Ghannoum, M. (2012). The EXTRIP (EXtracorporeal TReatments in Poisoning) workgroup: Guideline methodology. Clinical Toxicology, 50(5), 403-413. https://doi.org/10.3109/15563650.2012.683436