title: The EXTRIP (EXtracorporeal TReatments In Poisoning) workgroup: guideline methodology.
abstract: Extracorporeal treatments (ECTRs), such as hemodialysis and hemoperfusion, are used in poisoning despite a lack of controlled human trials demonstrating efficacy. To provide uniform recommendations, the EXTRIP group was formed as an international collaboration among recognized experts from nephrology, clinical toxicology, critical care, or pharmacology and supported by over 30 professional societies. For every poison, the clinical benefit of ECTR is weighed against associated complications, alternative therapies, and costs. Rigorous methodology, using the AGREE instrument, was developed and ratified. Methods rely on evidence appraisal and, in the absence of robust studies, on a thorough and transparent process of consensus statements. Twenty-four poisons were chosen according to their frequency, available evidence, and relevance. A systematic literature search was performed in order to retrieve all original publications regardless of language. Data were extracted on a standardized instrument. Quality of the evidence was assessed by GRADE as: High = A, Moderate = B, Low = C, Very Low = D. For every poison, dialyzability was assessed and clinical effect of ECTR summarized. All pertinent documents were submitted to the workgroup with a list of statements for vote (general statement, indications, timing, ECTR choice). A modified Delphi method with two voting rounds was used, between which deliberation was required. Each statement was voted on a Likert scale (1-9) to establish the strength of recommendation. This approach will permit the production of the first important practice guidelines on this topic.
authors.affiliation: Department of Medical Biology, Sacre-Coeur Hospital, University of Montreal, Montreal, Canada.
authors.forename: Valéry
authors.initials: V
authors.lastname: Lavergne
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Nolin
authors.forename: Robert S
authors.initials: RS
authors.lastname: Hoffman
authors.forename: Darren
authors.initials: D
authors.lastname: Roberts
authors.forename: Sophie
authors.initials: S
authors.lastname: Gosselin
authors.forename: David S
authors.initials: DS
authors.lastname: Goldfarb
authors.forename: Jan T
authors.initials: JT
authors.lastname: Kielstein
authors.forename: Robert
authors.initials: R
authors.lastname: Mactier
authors.forename: Robert
authors.initials: R
authors.lastname: Maclaren
authors.forename: James B
authors.initials: JB
authors.lastname: Mowry
authors.forename: Timothy E
authors.initials: TE
authors.lastname: Bunchman
authors.forename: David
authors.initials: D
authors.lastname: Juurlink
authors.forename: Bruno
authors.initials: B
authors.lastname: Megarbane
authors.forename: Kurt
authors.initials: K
authors.lastname: Anseeuw
authors.forename: James F
authors.initials: JF
authors.lastname: Winchester
authors.forename: Paul I
authors.initials: PI
authors.lastname: Dargan
authors.forename: Kathleen D
authors.initials: KD
authors.lastname: Liu
authors.forename: Lotte C
authors.initials: LC
authors.lastname: Hoegberg
authors.forename: Yi
authors.initials: Y
authors.lastname: Li
authors.forename: Diane P
authors.initials: DP
authors.lastname: Calello
authors.forename: Emmanuel A
authors.initials: EA
authors.lastname: Burdmann
authors.forename: Christopher
authors.initials: C
authors.lastname: Yates
authors.forename: Martin
authors.initials: M
authors.lastname: Laliberté
authors.forename: Brian Scott
authors.initials: BS
authors.lastname: Decker
authors.forename: Carlos Augusto
authors.initials: CA
authors.lastname: Mello-Da-Silva
authors.forename: Eric
authors.initials: E
authors.lastname: Lavonas
authors.forename: Marc
authors.initials: M
authors.lastname: Ghannoum
mesh_terms: D000818:Animals; D005112:Extracorporeal Circulation / Q000379:methods*; D006464:Hemoperfusion / Q000379:methods; D006801:Humans; D007391:International Cooperation; D011041:Poisoning / Q000628:therapy*; D017410:Practice Guidelines as Topic; D006435:Renal Dialysis / Q000379:methods*; D017582:Renal Replacement Therapy / Q000379:methods; D016060:Sorption Detoxification / Q000379:methods