Journal of Clinical Toxicology
Open Access

Abstract

Carbon Monoxide Exposure Associated with High-risk Features and Intentional Exposure are Infrequently Treated with Hyperbaric Oxygen

Renee L Riggs, Frederick W Fiesseler, Neeraja Kairam, Lisa Reedman, Dave Salo and Richard Shih

Data is conflicting regarding the management of carbon monoxide (CO) poisoned patients.

Objective: To determine the emergency department management (ED) of intentional CO poisoned patients regarding hyperbaric oxygen therapy (HBO₂), compared to those who are unintentionally exposed.

Methodology

Design: A multi-center retrospective emergency department cohort study.

Population: Consecutive patients presenting to 23 Northeastern United States hospital emergency departments, comprising academic, non-academic, urban, suburban, and rural hospitals with the International Classification of Disease primary diagnosis of “toxic effects CO”. Patients were “a priori” divided into intentional/unintentional and “high-risk” (syncope, serum carboxyhemoglobin level ≥ 20%, change in mental status, cardiac arrest, and/or seizures) or “low-risk” (without the above).

Results: “Toxic effects of CO” was diagnosed in 1136 patients, 1026 charts were available for analysis and 52 (4.8%) met inclusion criteria as intentional.Mean age was 40 years (standard deviation (SD) ± 13), for intentional patients. Overall, high risk intoxication was reported in 12% (N = 124/1026) of patients, compared to 50% (N= 26/52) of the intentional patients (p ≤ 0.0001). Mean overall CO level was 7%, compared to an intentional rate of 17% (p ≤ 0.0001). Fifty percent of intentionally exposed high-risk patients received HBO₂, while only 36% (N = 45/124) of high-risk patients overall did (p = 0.27).

Conclusions: Carbon monoxide poisoned patients with intentional exposures and high-risk clinical features are not more likely to receive HBO₂.