המידע באדיבות מדיקונטקסט
Last Updated: 2001-07-20 10:06:07 EDT (Reuters Health)
By Anthony J. Brown, MD
WESTPORT, CT (Reuters Health) – Hyperbaric oxygen therapy does not seem to prevent the uniformly fatal outcome of cardiac arrest after carbon monoxide (CO) poisoning, according to a report published in the July issue of the Annals of Emergency Medicine.
Dr. Neil B. Hampson and Jeannette L. Zmaeff, from Virginia Mason Medical Center, in Seattle, assessed the outcomes of 18 patients, 3 to 72 years of age, who received hyperbaric oxygen after being resuscitated from a CO-associated cardiac arrest. A postal questionnaire involving a similar hypothetical scenario was sent to medical directors of North American hyperbaric oxygen facilities.
The source of CO included house fires and automobile exhausts in 10 and 8 patients, respectively, the authors note. On average, patients had a carboxyhemoglobin level of 31.7% and an arterial pH of 7.14. More than half of the patients presented with a bradydysrhythmia. The average delay between poisoning and hyperbaric oxygen therapy was 4.3 hours. All 18 patients died during their hospitalization, the researchers state.
Despite no survivors in the case series, medical directors believed that a hypothetical patient with a similar presentation was 74% likely to survive.
"I believe that hyperbaric oxygen is an effective therapy for carbon monoxide poisoning, but I think we've identified a subset of patients for whom it is rarely, if ever, effective," Dr. Hampson told Reuters Health. "The prognosis for an out-of-hospital cardiac arrest is not good in any case, but when you have an etiology with an added insult to the brain, the arrest is rarely survivable," he said.
"I don't think the chance of survival is zero, just because 18 consecutive patients failed to survive," Dr. Hampson pointed out. "After reviewing the literature, I found a few patients that may have survived such an insult," he said.
However, based on the current findings, "if I get a referral from a physician 200 miles away who wants to transfer one of these patients to our facility for hyperbaric oxygen therapy, I am going to discourage them from making the transfer," Dr. Hampson said. "I just don't think the appropriate risk/benefit ratio is there," he added.
Ann Emerg Med 2001;38:36-41.
-Westport Newsroom 203 319 2700
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