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Utility of 2-Pyridine Aldoxime Methyl Chloride (2-PAM) for Acute Organophosphate Poisoning: A Systematic Review and Meta-Analysis

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A Correction to this article was published on 03 January 2018

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Abstract

Organophosphates (OP) account for the majority of pesticide-related unintentional or intentional poisonings in lower- and middle-income countries. The therapeutic role of atropine is well-established for patients with acute OP poisoning. The benefit of adding 2-pyridine aldoxime methyl chloride (2-PAM), however, is controversial. We performed a systematic review and meta-analysis of available randomized controlled trials (RCT) to compare 2-PAM plus atropine in comparison to atropine alone for acute OP poisoning. We searched PubMed, EMBASE, and SCOPUS up to March 2017. The Cochrane review handbook was used to assess the risk of bias. Data were abstracted and risk ratios (RR) were calculated for mortality, rate of intubation, duration of intubation, intermediate syndrome, and complications such as hospital-acquired infections, dysrhythmias, and pulmonary edema. We found five studies comprising 586 patients with varying risks of bias. The risk of death (RR = 1.5, 95% CI 0.9–2.5); intubation (RR = 1.3, 95% CI 1.0–1.6); intermediate syndrome (RR = 1.6, 95% CI 1.0–2.6); complications (RR = 1.2, 95% CI 0.8–1.8); and the duration of intubation (mean difference 0.0, 95% CI − 1.6–1.6) were not significantly different between the atropine plus 2-PAM and atropine alone. Based on our meta-analysis of the available RCTs, 2-PAM was not shown to improve outcomes in patients with acute OP poisoning.

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Change history

  • 03 January 2018

    The names of coauthors Roshanak Benabbas and and Ian S. deSouza were given incorrectly (as “Roshnak Benabbas” and “Ian de Souza”, respectively) in this article as originally published.

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Acknowledgements

The authors would like to thank Christopher Stewart, senior assistant librarian at SUNY Downstate Medical Center, for his help in formulating the literature search strategy. The authors would like to thank Dr. Nicholas Buckley.

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Authors and Affiliations

  1. Department of Emergency Medicine, Downstate Medical Center, State University of New York, Albany, NY, USA

    Adam Blumenberg, Roshanak Benabbas, Ian S. deSouza, Lorenzo Paladino, Elliot Warman, Richard Sinert & Sage W. Wiener

  2. Department of Emergency Medicine, Kings County Hospital Center, 451 Clarkson Avenue, Brooklyn, NY, 11203, USA

    Adam Blumenberg, Roshanak Benabbas, Ian S. deSouza, Alyssa Conigliaro, Lorenzo Paladino, Richard Sinert & Sage W. Wiener

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  1. Adam Blumenberg
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  2. Roshanak Benabbas
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Correspondence to Sage W. Wiener.

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Additional information

The original version of this article was revised: The names of coauthors Roshanak Benabbas and and Ian S. deSouza were given incorrectly (as “Roshnak Benabbas” and “Ian de Souza”, respectively) in this article as originally published.

A correction to this article is available online at https://doi.org/10.1007/s13181-017-0648-y.

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Blumenberg, A., Benabbas, R., deSouza, I.S. et al. Utility of 2-Pyridine Aldoxime Methyl Chloride (2-PAM) for Acute Organophosphate Poisoning: A Systematic Review and Meta-Analysis. J. Med. Toxicol. 14, 91–98 (2018). https://doi.org/10.1007/s13181-017-0636-2

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