Extracorporeal Blood Purification for Acute Poisoning

Extracorporeal blood purification therapies (EBPTs) have been used in poisoning for over 50 years and have assumed a greater role at the bedside, especially in the absence of antidotes or when antidotes are not effective. Technological improvements have resulted in increased efficacy, enabling the removal of toxins through different mechanisms that go beyond the classic intermittent hemodialysis with low-, medium-, or high-flux membranes. For the clinician, the consideration of EBPT in the treatment of poisoning depends on the characteristics of toxins amenable to extracorporeal removal (e.g., molecular weight, volume of distribution, protein binding, log P), the choice of extracorporeal treatment modality for a given poisoning, and whether the benefit of the procedure justifies additive risk. Within the current decade, the Extracorporeal Treatment in Poisoning workgroup has systematically reviewed and published treatment recommendations with an improved evidence base.