Resuscitative Intravenous Lipid Emulsion Therapy in Pediatrics: Is There a Role?

Intravenous lipid emulsion (ILE) rescue therapy has recently become a focus of much investigation in the poisoned patient. Initially used to reverse local anesthetic toxicity, there have been numerous human case reports and controlled animal studies describing the use of resuscitative ILE in other poisoning scenarios with cardiovascular collapse. The mechanism of action has not been elucidated but may involve altering fatty acid metabolism, increasing myocyte calcium stores, and creating an artificial compartment or "lipid sink" in the plasma to sequester toxin. However, clear clinical benefits over current available treatments have not yet been established, and much is still unknown. There are safety concerns with the use of ILE, which require further investigation. Lastly, data in pediatric patients are scant, especially in the non-local anesthetic toxicity scenario. The purpose of this article is to review the proposed mechanisms of lipid therapy, summarize the animal and human evidence for its efficacy, review evidence for resuscitative ILE in the pediatric population, and discuss safety issues and potential adverse effects.