Human chlorine gas exposition and its management - an umbrella review on human data

Even though exposure to chlorine gas has been quite frequent in the past few decades, no specific antidotes exist. This umbrella review aimed to investigate possible recommendations for treatment after a chlorine gas exposure. A published systematic review protocol that adapted the existing Navigation Guide methodology was used for including studies without comparator. Using PubMed, Web of Science, Google scholar for all potentially relevant systematic reviews, two authors independently included papers and extracted data. The risk of bias and quality of evidence was assessed by two independent review teams blinded to each other. A qualitative summary of the study findings was conducted for this overview. There were a total of 31 studies, from 4 systematic reviews, that met the inclusion criteria, comprising 3567 reported cases, with only two studies with comparators. Six studies reported pre-hospital management of patients after exposure to chlorine gas. With respect to the treatment, the most used were oxygen therapy, endotracheal intubation, β2-agonists, and corticosteroids. This review found a high quality of evidence for the effectiveness of pre-hospital management (i.e. exposure cessation) on survival at hospital discharge after exposure to chlorine gas. Oxygen administration was effective with moderate quality of evidence, as well as other types of treatment (e.g. β2, corticosteroids), but with a low level of evidence. This umbrella review highlighted the low level of evidence for existing treatments of chlorine gas poisoning. This project was supported by the French Pays de la Loire region and Angers Loire Métropole (TEC-TOP project). There is no award/grant number. The review protocol was registered on PROSPERO under the registration number CRD42021231524.