The availability and use of charcoal hemoperfusion in the treatment of poisoned patients.
BACKGROUND
Charcoal hemoperfusion (CHP) has been one of the preferred methods to enhance the elimination of certain toxins in selected poisoned patients. However, the availability of CHP may be limited because of the expense of cartridges, their narrow indications, and their limited shelf life. Improvements in hemodialysis (HD) technology may contribute to making CHP obsolete. We investigated the availability of CHP in in-hospital HD units at hospitals receiving ambulances dispatched through New York City's emergency response system, hereafter referred to as 911-receiving hospitals, and their recent history of CHP use in poisoned patients.


METHODS
The medical directors or managers of all in-hospital HD units in the 911-receiving hospitals of New York City were contacted by E-mail and/or telephone. Participants were administered a standard survey that included questions regarding the availability of CHP cartridges and the date and indication for last CHP use. Participants at institutions that did not stock CHP cartridges were questioned about their opinions on the utility of CHP.


RESULTS
Forty-two in-hospital HD units were surveyed, of which 34 (81%) completed the survey. Ten units (29%) had CHP cartridges available for immediate use. Each of these 10 units stocked between 1 and 4 adult-size CHP cartridges, and 1 unit stocked 2 pediatric-size CHP cartridges. Nine units had in-date CHP cartridges, and 1 unit had only expired CHP cartridges. Only 3 units performed CHP in the past 5 years (2 units, theophylline poisonings; 1 unit, aluminum overload). In the 24 units without CHP cartridges, 21 directors believed that most common toxins could be removed effectively through HD and thus CHP rarely was indicated. Only 1 director cited expense as a factor in not stocking CHP cartridges. Two directors reported no specific reason for not stocking the cartridges.


CONCLUSIONS
CHP cartridges are available in only approximately one third of 911-receiving hospitals in New York City. CHP is infrequently performed to enhance toxin elimination in poisoned patients.
Shalkham
Anna S
AS
New York Poison Control Center, New York City, USA. shulea01@hotmail.com
Kirrane
Barbara M
BM
Hoffman
Robert S
RS
Goldfarb
David S
DS
Nelson
Lewis S
LS
D002606:Charcoal / Q000627:therapeutic use*; D004349:Drug Packaging; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006464:Hemoperfusion / Q000379:methods / Q000706:statistics & numerical data*; D006801:Humans; D009519:New York City; D011041:Poisoning / Q000628:therapy*; D012189:Retrospective Studies
D002606:Charcoal