Is oxygen required before atropine administration in organophosphorus or carbamate pesticide poisoning? - A cohort study.

Publisher: Informa Healthcare Country of Publication: England NLM ID: 101241654 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1556-9519 (Electronic) Linking ISSN: 15563650 NLM ISO Abbreviation: Clin Toxicol (Phila) Subsets: MEDLINE

Publication: London : Informa Healthcare
Original Publication: Philadelphia, PA : Taylor & Francis, c2005-

Atropine/*therapeutic use ; Carbamates/*poisoning ; Organophosphate Poisoning/*therapy ; Oxygen/*administration & dosage ; Pesticides/*poisoning; Adult ; Antidotes/administration & dosage ; Antidotes/therapeutic use ; Atropine/administration & dosage ; Cholinesterase Inhibitors/poisoning ; Cohort Studies ; Female ; Heart Arrest/epidemiology ; Humans ; Incidence ; Male ; Middle Aged ; Prospective Studies ; Resuscitation/methods ; Sri Lanka/epidemiology ; Time Factors

Background: Early and adequate atropine administration in organophosphorus (OP) or carbamate insecticide poisoning improves outcome. However, some authors advise that oxygen must be given before atropine due to the risk of inducing ventricular dysrhythmias in hypoxic patients. Because oxygen is frequently unavailable in district hospitals of rural Asia, where the majority of patients with insecticide poisoning present, this guidance has significant implications for patient care. The published evidence for this advice is weak. We therefore performed a patient cohort analysis to look for early cardiac deaths in patients poisoned by anticholinesterase pesticides.
Methods: We analysed a prospective Sri Lankan cohort of OP or carbamate-poisoned patients treated with early atropine without the benefit of oxygen for evidence of early deaths. The incidence of fatal primary cardiac arrests within 3 h of admission was used as a sensitive (but non-specific) marker of possible ventricular dysrhythmias.
Results: The cohort consisted of 1957 patients. The incidence of a primary cardiac death within 3 h of atropine administration was 4 (0.2%) of 1957 patients. The majority of deaths occurred at a later time point from respiratory complications of poisoning.
Conclusion: We found no evidence of a high number of early deaths in an observational study of 1957 patients routinely given atropine before oxygen that might support guidance that oxygen must be given before atropine. The published literature indicates that early and rapid administration of atropine during resuscitation is life-saving. Therefore, whether oxygen is available or not, early atropinisation of OP- and carbamate-poisoned patients should be performed.

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SCD/05 United Kingdom CSO_ Chief Scientist Office; 063560 United Kingdom WT_ Wellcome Trust

Keywords: Atropine; Carbamate; Organophosphorus; Oxygen; Ventricular dysrhythmia

0 (Antidotes)
0 (Carbamates)
0 (Cholinesterase Inhibitors)
0 (Pesticides)
7C0697DR9I (Atropine)
S88TT14065 (Oxygen)

Date Created: 20140510 Date Completed: 20140806 Latest Revision: 20220129

20240104

PMC4134047

10.3109/15563650.2014.915411

24810796