Fettiplace Michael R, McCabe Daniel J
a Medical Scientist Training Program , University of Illinois College of Medicine , Chicago , IL , USA.
b Department of Emergency Medicine , John H. Stroger Cook County Hospital , Chicago , IL , USA.
Clin Toxicol (Phila). 2017 Aug;55(7):617-623. doi: 10.1080/15563650.2017.1288911. Epub 2017 Feb 17.
The Lipid Emulsion Therapy workgroup, organized by the American Academy of Clinical Toxicology, recently conducted a systematic review, which subjectively evaluated lipid emulsion as a treatment for local anesthetic toxicity. We re-extracted data and conducted a meta-analysis of survival in animal models.
We extracted survival data from 26 publications and conducted a random-effect meta-analysis based on odds ratio weighted by inverse variance. We assessed the benefit of lipid emulsion as an independent variable in resuscitative models (16 studies). We measured Cochran's Q for heterogeneity and I to determine variance contributed by heterogeneity. Finally, we conducted a funnel plot analysis and Egger's test to assess for publication bias in studies.
Lipid emulsion reduced the odds of death in resuscitative models (OR =0.24; 95%CI: 0.1-0.56, p = .0012). Heterogeneity analysis indicated a homogenous distribution. Funnel plot analysis did not indicate publication bias in experimental models.
Meta-analysis of animal data supports the use of lipid emulsion (in combination with other resuscitative measures) for the treatment of local anesthetic toxicity, specifically from bupivacaine. Our conclusion differed from the original review. Analysis of outliers reinforced the need for good life support measures (securement of airway and chest compressions) along with prompt treatment with lipid.
由美国临床毒理学会组织的脂质乳剂治疗工作组最近进行了一项系统评价，主观评估了脂质乳剂作为局部麻醉药中毒的一种治疗方法。我们重新提取了数据，并对动物模型中的生存率进行了荟萃分析。
我们从26篇出版物中提取了生存数据，并基于逆方差加权的比值比进行了随机效应荟萃分析。我们在复苏模型（16项研究）中评估了脂质乳剂作为自变量的益处。我们测量了用于异质性的Cochran's Q和I以确定异质性导致的方差。最后，我们进行了漏斗图分析和Egger检验以评估研究中的发表偏倚。
脂质乳剂降低了复苏模型中的死亡几率（OR = 0.24；95%CI：0.1 - 0.56，p = 0.0012）。异质性分析表明分布均匀。漏斗图分析未表明实验模型中存在发表偏倚。
对动物数据的荟萃分析支持使用脂质乳剂（与其他复苏措施联合使用）治疗局部麻醉药中毒，特别是布比卡因中毒。我们的结论与原综述不同。对异常值的分析强化了良好生命支持措施（确保气道通畅和进行胸外按压）以及及时使用脂质乳剂治疗的必要性。
