Hemoadsorption Therapy for Calcium Channel Blocker Overdose at a Tertiary-level Intensive Care Unit: A Retrospective Study.

Abstract

Objective: To describe the burden of calcium channel blocker (CCB) overdose at a tertiary intensive care unit (ICU).

Design and setting: Retrospective study of patients admitted to the ICU with CCB overdose from 2020 to 2022.

Participants: Adult participants with clinically confirmed CCB overdose.

Main outcome: Admission frequency, management strategies, and patient outcomes.

Results: A total 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 insulin euglycemic therapy (HIET) (71%), calcium (42%), methylene blue (4%), and fluid therapy (100%). Thirteen patients (54%) received hemoadsorption therapy (HA), and eleven received standard of care (SoC) based on current guidelines. The resin hemoadsorption group had a higher SAPS II score (p = 0.002), and a greater total maximal vasopressor dose (p = 0.001) than SoC group. 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) compared to the SoC group. There was one death in the HA group (7.7%) and two in the SoC group (18.2%).

Conclusion: Calcium channel blocker overdose is an important and life-threatening cause of toxicology admissions in the ICU. Modern resin HA may contribute to improved hemodynamic stability providing a safe and important rescue therapy in cases with refractory shock. Well-designed studies are required to confirm its role in enhancing drug clearance thereby improving the hemodynamic state and clinical outcomes.

How to cite this article: Omar S, Shukla V, Khan AB, Dangor Z. Hemoadsorption Therapy for Calcium Channel Blocker Overdose at a Tertiary-level Intensive Care Unit: A Retrospective Study. Indian J Crit Care Med 2025;29(2):130-136.