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

Blumenberg, A. and Benabbas, R. and deSouza, I. S. and Conigliaro, A. and Paladino, L. and Warman, E. and Sinert, R. and Wiener, S. W.

J Med Toxicol (2018) 14: 91–98

DOI: 10.1007/s13181-017-0636-2

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.

Citation

Blumenberg, A., Benabbas, R., deSouza, I. S., Conigliaro, A., Paladino, L., Warman, E., Sinert, R., & Wiener, S. W. (2018). Utility of 2-Pyridine Aldoxime Methyl Chloride (2-PAM) for Acute Organophosphate Poisoning: A Systematic Review and Meta-Analysis. J Med Toxicol, 14(1), 91–98. https://doi.org/10.1007/s13181-017-0636-2 Animals, Humans, Antidotes/*therapeutic use, Organophosphate Poisoning/*drug therapy, *Organophosphates, *Oximes, *Poisoning, *Pralidoxime compounds, Cholinesterase Reactivators/*therapeutic use, Pralidoxime Compounds/*therapeutic use

Keywords

• Animals
• Humans
• Antidotes/*therapeutic use
• Organophosphate Poisoning/*drug therapy
• *Organophosphates
• *Oximes
• *Poisoning
• *Pralidoxime compounds
• Cholinesterase Reactivators/*therapeutic use
• Pralidoxime Compounds/*therapeutic use