Use of Out-of-Hospital ethanol administration to improve outcome in mass methanol outbreaks

Sergey Zakharov, Daniela Pelclova, Pavel Urban, Tomas Navratil, Olga Nurieva, Katerina Kotikova, Pavel Diblik, Ivana Kurcova, Jaromir Belacek, Martin Komarc, Michael Eddleston, Knut Eric Hovda

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: Methanol poisoning outbreaks are a global public health issue with delayed treatment causing poor outcomes. Pre-hospital ethanol administration may improve outcome but the difficulty of doing research in outbreaks has meant that its effects have never been assessed. We studied the effect of pre-hospital ethanol in patients treated during a methanol outbreak in the Czech Republic between 2012 and 2014.
Methods: Observational case-series study of 100 hospitalized patients with confirmed methanol poisoning. Pre-hospital ethanol as a “first aid antidote” was administered by paramedic or medical staff before the confirmation of diagnosis to 30 patients; 70 patients did not receive pre-hospital ethanol from the staff (12 patients self-administered ethanol shortly before presentation).
Results: The state of consciousness at first contact with paramedic or medical staff, delay to admission, and serum methanol concentration were similar among groups. The median serum ethanol on admission in the patients with pre-hospital administration by paramedic or medical staff was 84.3 [IQR 32.7-129.5] mg/dL. No patients with positive serum ethanol on admission died compared to 21 with negative serum ethanol (0% vs. 36.2%). Patients receiving pre-hospital ethanol survived without visual and central nervous system sequelae more often than those not receiving (90.5% vs. 19.0%). A positive association was present between pre-hospital ethanol administration by paramedic or medical staff, serum ethanol concentration on admission, and both total survival and survival without sequelae of poisoning.
Conclusions: We found a positive association between pre-hospital ethanol administration and improved clinical outcome. During mass methanol outbreaks, conscious adults with suspected poisoning should be considered for administration of pre-hospital ethanol to reduce morbidity and mortality.
Original languageEnglish
JournalAnnals of Emergency Medicine
DOIs
Publication statusPublished - 1 Mar 2016

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