DOI: http://dx.doi.org/10.18203/2394-6040.ijcmph20214297

Carbon monoxide poisoning: assessment, treatment, and outcomes

Ahmed Ragab Zein, Eidan Bakheet Almalki, Hani Ahmed Almasabi, Hatem Tarig Alzahrani, Rehab Hassan Alabdali, Zainab Kadim Alsalamah, Haitham Rasheed Alhaeti, Abdullah Hadi Alsuroji, Ashwaq Hussain Bugis, Fatima Abdullah Al Sadiq, Muath Yousef Almohammadi

Abstract


Many complications can occur secondary to carbon monoxide (CO), including serious complications to the cardiovascular system and neurological complications that might even end up with death. It has been estimated that around 30-40% of patients suffering from CO poisoning usually die before presenting at the emergency department. Accordingly, management of these patients is a critical approach to enhance the outcomes and prognosis of the affected patients. In the present literature review, we have discussed the current evidence regarding the assessment, treatment, and outcomes of patients with CO poisoning. Our results indicate that attending clinicians should adequately assess the suspected patients with their clinical manifestations, laboratory parameters, and history of exposure to CO. Besides, imaging techniques can also be indicated in some cases with a suspected brain injury. After the diagnosis has been successfully established, management of symptoms and administration of the validated therapeutic modalities should be rapidly performed to enhance the outcomes and intervene against the development of further complications. However, it should be noted that even after achieving adequate management, long-term complications might develop with the survivors and can even lead to death. Accordingly, further research is needed to help formulate successful interventions that can enhance the prognosis of the condition.


Keywords


CO, Poisoning, Toxicology, Management, Complications, Assessment, Diagnosis

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References


Hampson NB. Carboxyhemoglobin: a primer for clinicians. Undersea hyperbaric med. 2018;45(2):165-71.

Otterness K, Ahn C. Emergency department management of smoke inhalation injury in adults. Emergency med pract. 2018;20(3):1-24.

Buboltz JB, Robins M. Hyperbaric Treatment Of Carbon Monoxide Toxicity. In: StatPearls. Treasure Island (FL): StatPearls Publishing Copyright © 2021, StatPearls Publishing LLC. 2021.

Reumuth G, Alharbi Z, Houschyar KS. Carbon monoxide intoxication: What we know. Burns. j Int Society Burn Injuries. 2019;45(3):526-30.

Dubey A, Chouksey D. Carbon monoxide toxicity: A reversible damage to brain. Neurology India. 2017;65(3):672-3.

Levy RJ. Anesthesia-Related Carbon Monoxide Exposure: Toxicity and Potential Therapy. Anesthesia analgesia. 2016;123(3):670-81.

Hampson NB, Piantadosi CA, Thom SR, Weaver LK. Practice recommendations in the diagnosis, management, and prevention of carbon monoxide poisoning. Am j respiratory cri care med. 2012;186(11):1095-101.

Penney DG. Chronic carbon monoxide poisoning: a case series. In: Carbon Monoxide Poisoning. CRC Press. 2007:577-594.

Guzman JA. Carbon monoxide poisoning. Crit care clin. 2012;28(4):537-48.

Kinoshita H, Türkan H, Vucinic S. Carbon monoxide poisoning. Toxicol rep. 2020;7:169-73.

Townsend CL, Maynard RL. Effects on health of prolonged exposure to low concentrations of carbon monoxide. Occupational environmental med. 2002;59(10):708-11.

Weaver LK. Clinical practice. Carbon monoxide poisoning. N Eng j med. 2009;360(12):1217-25.

Barker SJ, Curry J, Redford D, Morgan S. Measurement of carboxyhemoglobin and methemoglobin by pulse oximetry: a human volunteer study. Anesthesiology. 2006;105(5):892-7.

Hampson NB, Weaver LK. Noninvasive CO measurement by first responders. A suggested management algorithm. J emergency med services. 2006;31(5):S10-12.

Hampson NB. Noninvasive pulse CO-oximetry expedites evaluation and management of patients with carbon monoxide poisoning. Am j emergency med. 2012;30(9):2021-4.

Weaver LK, Churchill SK, Deru K, Cooney D. False positive rate of carbon monoxide saturation by pulse oximetry of emergency department patients. Respiratory care. 2013;58(2):232-240.

Dziewierz A, Ciszowski K, Gawlikowski T. Primary angioplasty in patient with ST-segment elevation myocardial infarction in the setting of intentional carbon monoxide poisoning. J emergency med. 2013;45(6):831-4.

Henry CR, Satran D, Lindgren B, Adkinson C, Nicholson CI, Henry TD. Myocardial injury and long-term mortality following moderate to severe carbon monoxide poisoning. JAMA. 2006;295(4):398-402.

Kaya H, Coşkun A, Beton O. COHgb levels predict the long-term development of acute myocardial infarction in CO poisoning. Am j emergency med. 2016;34(5):840-44.

Weaver L, Hopkins R, Churchill S, Deru K. Neurological outcomes 6 years after acute carbon monoxide poisoning. Undersea hyperbaric med. 2008;35:4.

Hopkins R, Weaver L. Cognitive outcomes 6 years after acute carbon monoxide poisoning. Undersea hyperbaric med. 2008;35:4.

Hsiao CL, Kuo HC, Huang CC. Delayed encephalopathy after carbon monoxide intoxication--long-term prognosis and correlation of clinical manifestations and neuroimages. Acta neurologica Taiwanica. 2004;13(2):64-70.

Chambers CA, Hopkins RO, Weaver LK, Key C. Cognitive and affective outcomes of more severe compared to less severe carbon monoxide poisoning. Brain injury. 2008;22(5):387-95.

Rose JJ, Wang L, Xu Q. Carbon monoxide poisoning: pathogenesis, management, and future directions of therapy. Am j respiratory crit care med. 2017;195(5):596-606.

Parkinson RB, Hopkins RO, Cleavinger HB. White matter hyperintensities and neuropsychological outcome following carbon monoxide poisoning. Neurology. 2002;58(10):1525-32.

O'Donnell P, Buxton PJ, Pitkin A, Jarvis LJ. The magnetic resonance imaging appearances of the brain in acute carbon monoxide poisoning. Clin radiol. 2000;55(4):273-80.

Lo CP, Chen SY, Lee KW. Brain injury after acute carbon monoxide poisoning: early and late complications. Am j roentgenol. 2007;189(4):W205-11.

Brown S, Piantadosi C, Gorman D. Hyperbaric oxygen for carbon monoxide poisoning. Lancet. 1989;334(8670):1032-3.

Kindwall EP. Hyperbaric medicine practice. Best Publishing Company. 1999.

Weaver LK, Howe S, Hopkins R, Chan KJ. Carboxyhemoglobin half-life in carbon monoxide-poisoned patients treated with 100% oxygen at atmospheric pressure. Chest. 2000;117(3):801-8.

Weaver LK. Hyperbaric oxygen therapy for carbon monoxide poisoning. Undersea hyperbaric med. 2014;41(4):339-54.

Ernst A, Zibrak JD. Carbon monoxide poisoning. N Eng j med. 1998;339(22):1603-8.

Myers R, Jones D, Britten J. Carbon monoxide half-life study. Paper presented at: Proceedings of the Eighth International Congress on Hyperbaric Medicine. Flagstaff, AZ: Best Publishing. 1987.

Prockop LD, Chichkova RI. Carbon monoxide intoxication: an updated review. J neurol sci. 2007;262(1-2):122-30.

Pace N, Strajman E, Walker EL. Acceleration of carbon monoxide elimination in man by high pressure oxygen. Science (New York, NY). 1950;111(2894):652-4.

Thom SR, Bhopale VM, Fisher D. Hyperbaric oxygen reduces delayed immune-mediated neuropathology in experimental carbon monoxide toxicity. Toxicol applied pharmacol. 2006;213(2):152-9.

Garrabou G, Inoriza JM, Morén C. Mitochondrial injury in human acute carbon monoxide poisoning: the effect of oxygen treatment. J environmental sci health Part C, Environmental carcinogenesis ecotoxicol rev. 2011;29(1):32-51.

Jurič DM, Finderle Ž, Šuput D, Brvar M. The effectiveness of oxygen therapy in carbon monoxide poisoning is pressure- and time-dependent: a study on cultured astrocytes. Toxicology letters. 2015;233(1):16-23.

Juurlink DN, Buckley N, Stanbrook MB, Isbister G, Bennett MH, McGuigan M. Hyperbaric oxygen for carbon monoxide poisoning. Cochrane database systematic rev. 2005;1.

Weaver LK, Hopkins RO, Chan KJ. Hyperbaric oxygen for acute carbon monoxide poisoning. N Eng j med. 2002;347(14):1057-67.

Wolf SJ, Lavonas EJ, Sloan EP, Jagoda AS. Clinical policy: Critical issues in the management of adult patients presenting to the emergency department with acute carbon monoxide poisoning. Ann emergency med. 2008;51(2):138-52.

Weaver LK, Valentine KJ, Hopkins RO. Carbon monoxide poisoning: risk factors for cognitive sequelae and the role of hyperbaric oxygen. Am j respiratory cri care med. 2007;176(5):491-7.

Suzuki O, Watanabe K. Drugs and poisons in humans. Springer. 2005.

Mitsui T, Ito M. Concentration of carboxyhemoglobin in blood to death. EISEI KAGAKU. 1990;36(2):158-61.

Teige B, Lundevall J, Fleischer E. Carboxyhemoglobin concentrations in fire victims and in cases of fatal carbon monoxide poisoning. Zeitschrift fur Rechtsmedizin J legal med. 1977;80(1):17-21.

Yoshida M, Adachi J, Watabiki T, Tatsuno Y, Ishida N. A study on house fire victims: age, carboxyhemoglobin, hydrogen cyanide and hemolysis. Forensic sci int. 1991;52(1):13-20.

Ellenhorn MJ, Barceloux D. Diagnosis and treatment of human poisoning. Med toxicol. 1997:609-10.

Hampson NB, Rudd RA, Hauff NM. Increased long-term mortality among survivors of acute carbon monoxide poisoning. Crit care med. 2009;37(6):1941-7.

Hampson NB, Bodwin D. Toxic CO-ingestions in intentional carbon monoxide poisoning. J emergency med. 2013;44(3):625-30.

Pages B, Planton M, Buys S. Neuropsychological outcome after carbon monoxide exposure following a storm: a case-control study. BMC neurol. 2014;14:153.