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AIMS: This meta-analysis aims to assess the efficacy and safety of adjunctive therapies in patients with organophosphate poisoning. METHODS: A comprehensive literature search was performed in PubMed, EMBASE, Cochrane Library, and Web of Science from database inception to August 21, 2024. Prospective randomized controlled trials (RCTs) evaluating emergency interventions for organophosphate poisoning were included in the analysis. Clinical outcomes including mortality, duration of mechanical ventilation, length of stay (LOS) and need for mechanical ventilation were collected. RESULTS: Compared with atropine alone, the atropine plus pralidoxime group showed a significantly higher risk of mortality (P = 0.020) and a longer LOS (P < 0.001), while no significant differences were observed in the need for mechanical ventilation or its duration. For the atropine plus FFP group, no significant differences were found in outcomes including mortality, LOS, or ventilatory parameters. Hemopurification combined with atropine significantly reduced both mortality (P = 0.020) and LOS (P = 0.001). NAC showed a trend towards reduced LOS, although the result was not statistically significant. MgSO4 and glycopyrrolate exhibited potential benefits in reducing LOS, although the results were not statistically significant. NaHCO3 significantly reduced LOS (P = 0.05). CONCLUSION: The use of pralidoxime may be associated with an increased risk of adverse outcomes, calling into question its routine application in organophosphate poisoning. In contrast, hemopurification was associated with a significant reduction in mortality and may represent a promising adjunctive therapeutic strategy.