Lipid Rescue has come a long way in a very short time. Lipid infusion now represents the standard of care in local anaesthetic intoxication and is available in every Anaesthetic Department, and increasingly in Emergency and Critical Care Units the world over. Evidence for use in non local-anaesthetic toxicity is building and while further basic science work is needed, there is sufficient basis to recommend lipid in cardiotoxicity attributable to highly lipophilic drugs unresponsive to established antidotes.

We would echo the comments of Jeffrey Brent in his editorial from the March edition of Critical care Medicine – the poisoned patient in your department (be it Anaesthetic, Emergency, or Intensive Care) cannot be considered dead, until they’re lipaemic and dead.

Such sentiment should rightly precipitate a flood of use in lipophilic drug intoxication, too great for journal editors to accommodate. If uptake of lipid is about to increase significantly a genuine opportunity is afforded to advance knowledge about a therapy for which much remains unknown – refinement of dosing, timing of administration, and adverse effects. The only rational way to collate such reports, and disseminate the experience of disparate individual clinicians and institutions is via a formal registry of use.

We would fully endorse the establishment of such a registry.

Dr Martyn Harvey (Emergency Physician; New Zealand)
Dr Grant Cave (Intensivist, Emergency Physician; New Zealand)

With evidence from a number of sources now appearing regularly in journals this should equip clinicians with the confidence to consider the role of Intralipid.

There is still a long way to go to marry up the scientific mechanisms governing lipid's influence on the outcome of drug toxicity and to elaborate if, when, how and how long lipid should best be administered.

As such every report of the clinical use of lipid represents an extremely important and relevant addition to our collective knowledge.

Accordingly, apparent successes and failures of lipid administration are noteworthy and introduction of a formal registry represents a useful logical next step.