Key result
Coated activated charcoal haemoperfusion did not significantly reduce amitriptyline-induced ECG alterations compared to standard care alone (P>0.05 for all variables).
Why the study?
Does coated activated charcoal haemoperfusion reduce pathological ECG changes in amitriptyline-poisoned pigs?
RCT (n=14)
Open-label
randomized
Does coated activated charcoal haemoperfusion reduce pathological ECG changes in amitriptyline-poisoned pigs?
Coated activated charcoal haemoperfusion does not significantly reduce pathological ECG changes in amitriptyline-poisoned pigs compared to standard care alone.
No ECG benefit from adding CAC-HP to charcoal in amitriptyline-poisoned pigs; leaves open clinical utility in human overdose.
Coated activated charcoal haemoperfusion (CAC-HP) does not reduce the plasma concentration in amitriptyline (AT)-poisoned pigs. The aim of this non-blinded, randomized, controlled animal trial was to determine if CAC-HP reduces the pathological ECG changes caused by AT poisoning. Fourteen female Danish Landrace pigs (mean weight 27.7 kg, range 20-35 kg (CAC-HP) and 24.4 kg, range 18-30 kg (control group, CG), n = 7 in each group) were included. After randomization, the pigs were anaesthetized and intravenously poisoned with AT. The intervention group underwent 4 hr of CAC-HP plus standard care (oral activated charcoal). Intervention was compared to standard care alone. From each pig, a 12-lead ECG and haemodynamic variables were obtained at baseline, at full AT loading dose, before and during CAC-HP. Baseline ECG variables (RR, PR, QRS, QTc, QTp, QTe, TpTe and TpTe/QT) for lead II, v2 and v5 were not significantly different (F = 0.035-0.297, p-values 0.421-0.919). Differences within groups over time and between groups were tested by anova repeated measures. For all variables, the time-plus-group level of significance revealed a p-value > 0.05. Severe cardiovascular arrhythmias occurred in both groups with 3 in the CAC-HP group versus 1 incident with premature death in the CG. The attenuating effect of CAC-HP to orally instilled activated charcoal alone on AT-induced ECG alterations did not differ significantly. We conclude that the use of modern CAC-HP as an adjunctive treatment modality in AT-poisoned pigs is inadequate.
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Jansen et al. (2017) conducted an RCT in Amitriptyline poisoning (n=14). Coated activated charcoal haemoperfusion (CAC-HP) vs. Standard care alone (oral activated charcoal) was evaluated on ECG alterations (RR, PR, QRS, QTc, QTp, QTe, TpTe and TpTe/QT) (p=> 0.05). Coated activated charcoal haemoperfusion did not significantly reduce amitriptyline-induced ECG alterations compared to standard care alone (P>0.05 for all variables).
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