Hyperbaric Oxygen for Acute Carbon Monoxide Poisoning

• Published in: The New England journal of medicine Vol. 347; no. 14; pp. 1057 - 1067
• Main Authors: Weaver, Lindell K, Hopkins, Ramona O, Chan, Karen J, Churchill, Susan, Elliott, C. Gregory, Clemmer, Terry P, Orme, James F, Thomas, Frank O, Morris, Alan H
• Format: Journal Article
• Language: English
• Published: Boston, MA Massachusetts Medical Society 03.10.2002
• Subjects: Acute Disease; Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Carbon monoxide poisoning; Carbon Monoxide Poisoning - complications; Carbon Monoxide Poisoning - therapy; Chemical and industrial products toxicology. Toxic occupational diseases; Cognition Disorders - etiology; Cognition Disorders - prevention & control; Consciousness; Depression - etiology; Depression - prevention & control; Double-Blind Method; Emergency and intensive care: techniques, logistics; Female; Gas, fumes; Humans; Hyperbaric Oxygenation - methods; Intensive care medicine; Logistic Models; Male; Medical sciences; Memory Disorders - etiology; Memory Disorders - prevention & control; Neuropsychological Tests; Oxygen Inhalation Therapy; Oxygen therapy; Patients; Perfusions. Catheterizations. Hyperbaric oxygenotherapy; Toxicology; Human; Treatment; Cognitive disorder; Complication; Sequela; Poisoning; Carbon monoxide; Hyperbaric oxygenotherapy
• ISSN: 0028-4793; 1533-4406; 1533-4406
• DOI: 10.1056/NEJMoa013121

Cognitive sequelae often occur after acute carbon monoxide poisoning. This double-blind, randomized trial assigned subjects either to three sessions in a hyperbaric-oxygen chamber or to one normobaric-oxygen treatment plus two sessions of exposure to normobaric room air, all administered within 24 hours after the end of exposure to carbon monoxide. Cognitive sequelae six weeks later were less frequent among persons who received hyperbaric-oxygen therapy (25.0 percent) than among those who received normobaric-oxygen treatment (46.1 percent, P=0.007). Differences were sustained 12 months after the episode of acute carbon monoxide poisoning. The results of this double-blind trial support the use of hyperbaric oxygen. Carbon monoxide poisoning is a serious health problem 1 , 2 resulting in approximately 40,000 visits to the emergency department annually in the United States. 2 , 3 Unfavorable cognitive sequelae (problems with memory, attention or concentration, and affect) can occur immediately after exposure and persist or can be delayed, but they generally occur within 20 days after carbon monoxide poisoning. 1 – 6 Cognitive sequelae lasting one month 5 , 7 – 9 or more 2 , 4 appear to occur in 25 to 50 percent of patients with loss of consciousness or with carboxyhemoglobin levels greater than 25 percent. 2 , 7 , 8 The recommended treatment for acute carbon monoxide poisoning . . .