title: Lipid emulsion improves survival in animal models of local anesthetic toxicity: a meta-analysis.
abstract: BACKGROUND
  The Lipid Emulsion Therapy workgroup, organized by the American Academy of Clinical Toxicology, recently conducted a systematic review, which subjectively evaluated lipid emulsion as a treatment for local anesthetic toxicity. We re-extracted data and conducted a meta-analysis of survival in animal models.
  
  
  METHODS
  We extracted survival data from 26 publications and conducted a random-effect meta-analysis based on odds ratio weighted by inverse variance. We assessed the benefit of lipid emulsion as an independent variable in resuscitative models (16 studies). We measured Cochran's Q for heterogeneity and I2to determine variance contributed by heterogeneity. Finally, we conducted a funnel plot analysis and Egger's test to assess for publication bias in studies.
  
  
  RESULTS
  Lipid emulsion reduced the odds of death in resuscitative models (OR =0.24; 95%CI: 0.1-0.56, p = .0012). Heterogeneity analysis indicated a homogenous distribution. Funnel plot analysis did not indicate publication bias in experimental models.
  
  
  CONCLUSIONS
  Meta-analysis of animal data supports the use of lipid emulsion (in combination with other resuscitative measures) for the treatment of local anesthetic toxicity, specifically from bupivacaine. Our conclusion differed from the original review. Analysis of outliers reinforced the need for good life support measures (securement of airway and chest compressions) along with prompt treatment with lipid.
authors.affiliation: a Medical Scientist Training Program , University of Illinois College of Medicine , Chicago , IL , USA.
authors.forename: Michael R
authors.identifier: http://orcid.org/0000-0001-6946-8355
authors.initials: MR
authors.lastname: Fettiplace
authors.affiliation: b Department of Emergency Medicine , John H. Stroger Cook County Hospital , Chicago , IL , USA.
authors.forename: Daniel J
authors.identifier: http://orcid.org/0000-0002-2779-001X
authors.initials: DJ
authors.lastname: McCabe
mesh_terms: D000779:Anesthetics, Local / Q000633:toxicity*; D000818:Animals; D002045:Bupivacaine / Q000633:toxicity*; D003131:Combined Modality Therapy; D004195:Disease Models, Animal; D004285:Dogs; D004339:Drug Compounding; D004655:Emulsions; D005217:Fat Emulsions, Intravenous / Q000737:chemistry / Q000494:pharmacology*; D016017:Odds Ratio; D011041:Poisoning / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D011817:Rabbits; D051381:Rats; D012151:Resuscitation / Q000379:methods*; D018570:Risk Assessment; D012307:Risk Factors; D013552:Swine; D013997:Time Factors
chemical_list: D000779:Anesthetics, Local; D004655:Emulsions; D005217:Fat Emulsions, Intravenous; D002045:Bupivacaine
keywords: Intravenous lipid emulsion; epinephrine; local anesthetics; meta-analysis; systematic review; toxicity