BIOScavenger Therapy in Organophosphate Poisoning

INTERVENTION: Treatment arms: 1. Fresh frozen plasma (FFP) (250 ml/bag): 4 bags on day 1 then 2 bags on day 2 and 3 2. 20% human albumin: 200 ml intravenous on day 1 then 100 ml on day 2 and 3 3. Control: do not receive either FFP or albumin. Common treatment: atropine and sedation schedule. No oximes are given. Follow‐up consists of clinical assessment and laboratory measurement of outcome measures. CONDITION: Organophosphate poisoning ; Injury, Occupational Diseases, Poisoning ; Toxic effect of pesticides PRIMARY OUTCOME: 1. Lower the incidence of intermediate syndrome, measured during hospital stay and determined at discharge; 2. Reduce effective circulating organophosphate levels, assayed directly and functionally and measured directly after the infusion of trial or placebo interventions SECONDARY OUTCOME: All measured during hospital stay and determined at discharge:; 1. Reduce the need for invasive mechanical ventilation; 2. Reduce mortality; 3. Decrease Intensive Care Unit (ICU)/hospital length of stay; 4. Reduce the duration of ventilation; 5. The total dose of atropine required (daily and cumulative); 6. Temporal profile of organophosphate levels (total and functional), serum butyrylcholinesterase (BuChE) level; 7. Adverse events and transfusion reactions INCLUSION CRITERIA: Patients (both males and females) above 15 years who present to the Emergency Department of Christian Medical College and Hospital (CMCH) with a diagnosis of organophosphate poisoning made on the basis of: 1. The typical clinical toxidrome of cholinergic and nicotinic manifestations 2. Reliable identification of the compound ingested based on the container brought by patient attendants or a subsequent confirmation by serum pseudocholinesterase levels of less than 1000 IU/L