UMEM Educational Pearls

Title: Intravenous lipid emulsion (ILE) therapy, where are we now?

Keywords: lipid emulsion therapy (PubMed Search)

Posted: 5/28/2020 by Hong Kim, MD, MPH
Click here to contact Hong Kim, MD, MPH

ILE is considered as one of the “last resort” therapy in cases of life-threatening drug-induced cardiogenic shock or cardiac arrest. Although there are numerous case reports and case series that showed “successful” or “positive” outcome with ILE, here is no clear evidence that lipid emulsion therapy is effective.

A group of researcher reviewed the National Poison Data System (NPDS) to investigate the failure of ILE therapy by reviewing the overdose fatalities reported to NPDS between 2010 and 2015.

Result:

Out of 6026 fatalities, 459 fatal overdose cases received ILE.
Majority involved either CCB or BB overdose (n=285; 62.1%)

Response to therapy (study cohort)

No response: 45%
Unknown response: 38%
Transient/minimal response: 7%
ROSC: 7.4%
Immediate worsening: 3%

Adverse effect (n=49)

ARDS with hypoxemia: 39
Lipemia causing delay in laboratory evaluation: 3
Lipemia causing failure of CRRT filter: 2
Worsening/new seizure: 2
Asystole: 2
Fat embolism: 1

Conclusion

The number of published cases of failed ILE outnumbers the published cases of ILE success.
Less than 5% of the patients with CCB or BB overdose had ROSC after ILE therapy.

References

Smolinske S et al. Utilization of lipid emulsion therapy in fatal overdose cases: an observational study. Clin Toxicol 2019;57:197-202