Intravenous lipid emulsion (ILE) is use as a therapy of last resort in refractory cardiovascular shock from toxicity of select agents (e.g. calcium channel blockers, beta blockers and select Na-channel blocking agents). There are number of case reports/series that showed positive cardiovascular/hemodynamic response after ILE, which are prone to publication bias. Results from limited number of human trials  have shown mixed results.

A study reviewed fatal cases of poisoning that received ILE from the National Poison Data System to characterize the clinical response of ILE therapy.

Results

N=459 cases from 2010 to 2015.

Most common substance involved

	N (%)	Number with ROSC (%)
Ca-channel blockers	183 (40)	8 (4.4)
Beta blockers	102 (22)	5 (4.9)
Bupropion*	53 (12)	5 (9.4)
TCAs*	48 (10)	2 (4.2)
Citalopram/escitalopram	36 (8)	0
Quetiapine	26 (6)	1 (3.8)
Flecainide	21 (5)	5 (23.8)
Local anesthetics – parenteral*	8 (2)	1 (12.5)

*Use of ILE supported by Lipid work group

Response rate

• No response: 45%
• Unknown response: 38%
• Transient/minimal response: 7%
• ROSC: 7%
• Immediate worsening: 3%

Possible adverse reactions (n)

• ARDS: 39
• Lipemia: 3
• Failure of CRRT filter: 2
• Worsening/new seizure: 2
• Asystole immediately after administration: 2
• Fat embolism: 1

 

Conclusion

• The number of failed cases of ILE therapy outnumbers the published cases of ILE success.
• Currently, there is a lack of data that shows the efficacy of ILE therapy.

References

Utilization of lipid emulsion therapy in fatal overdose cases: an observational study.