Effect of extracorporeal membrane oxygenation on mortality rate of aluminum phosphate poisoning: A systematic review and meta-analysis

Background: Aluminum phosphate (ALP) poisoning has a high mortality rate (MR) secondary to cardiogenic shock. Recently, extracorporeal membrane oxygenation (ECMO) showed a successful result in this issue. We conducted a systematic review and meta-analysis to compare the MR of patients with ALP poisoning who underwent ECMO versus those with conventional treatment. Materials and Methods: Two parallel databases' reviews were done to find the ECMO treatment-applied studies or conventional treatment-applied studies according to the PRISMA protocol. All studies in any languages and English conference abstracts were included for ECMO treatment-applied studies. Only English-language human observational studies, which reported MR, were included in conventional treatment-applied studies. All ETAS case reports were summarized and used as a newly generated cross-sectional study (NGCSS) for inclusion in the meta-analysis. Results: Out of 167 and 1043 records, 17 case reports (24 cases), 3 cross-sectional studies, and 9 conventional treatment-applied studies were selected. In meta-analysis NGCSS applied as the fourth cross-sectional ECMO treatment-applied studies. The overall MR of ECMO-treated cases (23% [95% confidence interval (CI): 7%-39%]) was significantly less than conventionally treated cases (60% [95% CI: 39%-63%]; P < 0.001). In ECMO-treated cases, the weighted mean difference (WMD) for age, blood pH, ALP dose, hospitalization, ECMO lag time, and ECMO duration were not statistically significant between survived and nonsurvived cases. However, WMD of cardiac ejection fraction (4.6%; 95% CI: 2.76%-6.39%; P < 0.0001), exposure to hospitalization lag time (-2.05; 95% CI: -4.05-0.14 h; P = 0.06), and length of hospital stay (16; 95% CI: 12.0-20.5 days; P < 0.0001) between survived and nonsurvived ETC were significant. Conclusion: ECMO reduced the MR of ALP-poisoned patients; however, it is a highly invasive and complicated procedure. Keywords: Extracorporeal membrane oxygenation, meta-analysis, pesticide, poisoning, survival rate