SynthesisThe western journal of emergency medicine2026
Therapeutic Interventions in Organophosphate Poisoning: An Umbrella Review of Systematic Reviews.
Synthesis in The western journal of emergency medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
1 citing paper in PubMed, 1 synthesis or guideline pooled it.
- Systematic Review and Meta-Analysis of Lipid Emulsion for Non-Local Anesthetic Poisoning.Journal of medical toxicology : official journal of the American College of Medical Toxicology · 2026Pooled it
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionOrganophosphate (OP) poisoning is a significant global health issue, particularly in tropical regions. Despite established treatments such as atropine and oximes, the effectiveness of other interventions remains uncertain. This umbrella review is a critical synthesis of evidence from systematic reviews and meta-analyses on OP self-poisoning.
methodsFollowing the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, we conducted a review of systematic reviews and meta-analyses published up to January 2025. Databases searched included PubMed, Epistemonikos, and the Cochrane Library. We performed quality assessment using A Measurement Tool to Assess Systematic Reviews, version 2 (AMSTAR-2), and applied the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to evaluate evidence certainty.
resultsOf 416 potential papers identified we assessed 27 for eligibility, of which 19 were included in the review. The papers evaluated 11 different interventions as an adjuvant to atropine. Oximes, although commonly used, showed neither benefit nor harm. The systematic reviews and meta-analyses on gastric lavage, plasma exchange with hemoperfusion, lipid emulsions, magnesium sulfate, penehyclidine, rhubarb, and xuebijing have reported significant reductions in mortality, but the evidence comes from very low-quality studies. Alkalinization was not found to be effective for OP poisoning. Evidence was limited by small sample size, inconsistent protocols, and geographical bias, with many studies originating from China.
conclusionAfter careful scrutiny of evidence pooled by various systematic reviews and meta-analyses, we found that atropine remains the mainstay of treatment for OP self-poisoning. It may be supplemented with oximes, as recommended by the World Health Organization. Gastric lavage has doubtful efficacy and may even be harmful. Additionally, we recommend against the routine use of penehyclidine, rhubarb, xuebijing, hemofiltration, plasma exchange with hemoperfusion, lipid emulsions, magnesium sulfate, and alkalinization in the management of OP self-poisoning.
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