Argument Against Hemoperfusion in Drug Overdose

To the Editor.—  The editorial by Michael C. Gelfand, MD (240:2762, 1979), in a recent issue of The Journal promotes the use of charcoal hemoperfusion in patients with drug overdose and stage IV coma. This more aggressive therapeutic approach was rationalized by a mortality of 34% in such patients, as reported by Arieff and Friedman¹ in 1973. In our experience, patients with severe drug overdose in stage IV coma have had a much lower mortality than that reported by these latter-mentioned authors. This has been accomplished with conservative care, an approach that others^2,3 have shown results in excellent survival.At the Montreal General Hospital, we have had an ongoing prospective study of adult suicidal drug overdose, conducted by the Division of Clinical Pharmacology, which supervises patient care from admission to discharge. Data for the four-year period from 1975 to 1979 show that 942 patients came to the emergency room