Hemoadsorption therapy for calcium channel blocker (CCB) overdose at a tertiary-level Intensive care unit in South Africa. A retrospective study

In this retrospective study, we describe the admission frequency, outcomes and management of adult participants with clinically confirmed CCB overdose admitted to the ICU from 2020 to 2022. Of 1719 ICU admissions over the study period, 24 (1,4%) had CCB overdose with a case fatality rate of 12.5% (3/24). Interventions included mechanical ventilation (MV) (71%), vasopressors (92%), high-dose euglycemic therapy (HIET) (71%), calcium (42%), methylene blue (4%) and fluid therapy (100%). Thirteen patients (54%) received hemoadsorption therapy (HA), and eleven received standard care (SoC) based on current guidelines. The HA group had a higher SAPS II score (p=0.002), and a greater total maximal vasopressor dose (p=0.001) compared to SoC. The HA group also had a lower admission mean arterial pressure (MAP), (p=0.014), a greater MAP increase at 48 hours (p=0.044) and a longer ICU length of stay (LOS) (p=0.004) vs. SoC. There was one death in the HA group (7.7%) and two in the SoC group (18.2%). CCB overdose is a life-threatening contributor to toxicology admissions in the ICU. Hemoadsorption therapy may provide a safe and important rescue therapy in cases with refractory shock. Well-designed studies are required to confirm its role in enhancing drug clearance and clinical outcomes.