Hyperbaric oxygen for carbon monoxide poisoning

A new Cochrane evidence-based medicine article from:
http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD002041/frame.html

Carbon monoxide poisoning is a very serious and potentially fatal condition that is often work-related. It is also commonly seen in suicide attempts with the use of car exhaust fumes. Carbon monoxide (CO) interferes with oxygen transport in the body and can damage a variety of organs including the brain. Management involves early recognition of the condition and giving oxygen which speeds up the elimination of carbon monoxide from the body.

The cases that the occupational physicians at QOH have seen have been where workers were in a poorly ventilated area with internal combustion engines running. Areas to look out for this include in car repair workshops, using petrol generators in confined/unventilated areas, or where forklifts with internal combustion engines are common and ventilation is limited (this can be more of a problem in winter when doors are more likely to be closed).

Traditionally if the patients were deemed sick enough at hospital they would be transported to one of the few hyperbaric chambers available. There has been doubt in the past about the benefit of this particularly because much of the CO is eliminated during high concentration oxygen therapy before the patient gets to the chamber!

The authors concluded:
“Existing randomized trials do not establish whether the administration of hyperbaric oxygen (HBO) to patients with carbon monoxide poisoning reduces the incidence of adverse neurologic outcomes. Additional research is needed to better define the role, if any, of HBO in the treatment of patients with carbon monoxide poisoning. This research question is ideally suited to a multi-center randomized controlled trial.”