Nephrology, Verdun Hospital, 4000 Lasalle Boulevard, Montreal, Quebec, Canada.
Clin J Am Soc Nephrol. 2012 Oct;7(10):1682-90. doi: 10.2215/CJN.01940212. Epub 2012 Jul 26.
The EXtracorporeal TReatments In Poisoning (EXTRIP) workgroup was formed to provide recommendations on the use of extracorporeal treatment (ECTR) in poisoning. To test and validate its methods, the workgroup reviewed data for thallium (Tl).
After an extensive search, the co-chairs reviewed the articles, extracted the data, summarized findings, and proposed structured voting statements following a predetermined format. A two-round modified Delphi method was chosen to reach a consensus on voting statements and RAND/UCLA Appropriateness Method to quantify disagreement. Blinded votes were compiled, returned, and discussed during a conference call. A second vote determined the final recommendations.
Forty-five articles met inclusion criteria. Only case reports and case series were identified, yielding a very low quality of evidence for all recommendations. Data on 74 patients, including 11 who died, were abstracted. The workgroup concluded that Tl is slightly dialyzable and made the following recommendations: ECTR is recommended in severe Tl poisoning (1D). ECTR is indicated if Tl exposure is highly suspected on the basis of history or clinical features (2D) or if the serum Tl concentration is >1.0 mg/L (2D). ECTR should be initiated as soon as possible, ideally within 24-48 hours of Tl exposure (1D), and be continued until the serum Tl concentration is <0.1 mg/L for a minimal duration of 72 hours (2D).
Despite Tl's low dialyzability and the limited evidence, the workgroup strongly recommended extracorporeal removal in the case of severe Tl poisoning.
体外治疗中毒（EXTRIP）工作组的成立旨在提供关于在中毒情况下使用体外治疗（ECTR）的建议。为了测试和验证其方法，工作组审查了铊（Tl）的数据。
经过广泛搜索，共同主席审查了文章，提取了数据，总结了发现结果，并按照预定的格式提出了结构化投票声明。选择两轮修改后的 Delphi 方法来就投票声明达成共识，并使用 RAND/UCLA 适宜性方法量化分歧。盲选投票在电话会议上进行汇总、返回和讨论。第二次投票确定了最终建议。
符合纳入标准的文章有 45 篇。仅确定了病例报告和病例系列，因此所有建议的证据质量都非常低。从 74 名患者中提取数据，其中 11 名患者死亡。工作组得出结论，Tl 略有可透析性，并提出了以下建议：在严重的 Tl 中毒情况下推荐使用 ECTR（1D）。如果基于病史或临床特征高度怀疑 Tl 暴露（2D）或血清 Tl 浓度>1.0mg/L（2D），则应进行 ECTR。应尽快开始 ECTR，理想情况下在 Tl 暴露后 24-48 小时内（1D），并持续进行，直到血清 Tl 浓度降至<0.1mg/L，持续至少 72 小时（2D）。
尽管 Tl 的可透析性低且证据有限，但工作组强烈建议在严重 Tl 中毒的情况下进行体外清除。
