Multicenter Retrospective Cohort Study Evaluating the Efficacy of Extracorporeal Therapies Versus Medical Therapy for the Treatment of Severe Baclofen Intoxication in Dogs.

Abstract

OBJECTIVE: To compare the outcome of treatment with extracorporeal therapy (ECT) and medical therapy (MED) in dogs with baclofen intoxication. DESIGN: Multicenter retrospective study between June 1, 2013, and October 31, 2023. SETTING: Six university teaching hospitals and three private specialty hospitals. ANIMALS: Eighty dogs treated for baclofen intoxication. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Twenty-nine of 80 (36%) dogs required endotracheal intubation, and 18 (23%) required mechanical ventilation (MV). Twenty-one (26%) dogs were treated with ECT, and 59 (74%) dogs received MED. The median estimated maximal exposure dose was 8.3&#xa0;mg/kg (range: 3.6-48&#xa0;mg/kg) in the ECT group and 5.7&#xa0;mg/kg (range: 0.46-132&#xa0;mg/kg) in the MED group (p&#xa0;=&#xa0;0.044). Nine of 21 (43%) dogs treated with ECT had an improvement in their level of consciousness. The mean duration of MV was 20&#xa0;&#xb1;&#xa0;11&#xa0;h in dogs treated with ECT and 23&#xa0;&#xb1;&#xa0;23&#xa0;h in dogs treated with MED. The median hospitalization time was 58&#xa0;h (range: 17-124&#xa0;h) in the ECT group and 24&#xa0;h (range: 0.5-188&#xa0;h) in the MED group. Survival was 95% for dogs treated with ECT and 92% for dogs treated with MED. Multivariable Poisson regression modeling was performed, controlling for estimated maximal exposure dose (mg/kg). ECT was associated with a shorter duration of MV (incidence rate ratio [IRR]: 0.76 [95% CI: 0.58-0.99]; p&#xa0;=&#xa0;0.038). However, ECT was associated with longer hospitalization times (IRR: 1.57 [95% CI: 1.45-1.71]; p&#xa0;<&#xa0;0.001). No association was found between the use of ECT and survival (odds ratio: 1.61 [95% CI: 0.16-16.13]; p&#xa0;=&#xa0;0.684). CONCLUSIONS: ECT is associated with high survival despite large estimated exposure doses. Although ECT was associated with a shorter duration of MV, no difference was found in survival or hospitalization time.