title: Treatment of carbon monoxide poisoning with hyperbaric oxygen and therapeutic hypothermia.
abstract: We present a preliminary case report series of severe, acute carbon monoxide poisoning in which both hyperbaric oxygen (HBO2) and therapeutic hypothermia (TH) were used to ameliorate neurological sequelae. Carbon monoxide poisoning is a standard indication for HBO2. While typically used postcardiac arrest, TH has been used for other types of hypoxic-ischemic brain injury. Four patients were found comatose from carbon monoxide exposure. They were intubated and treated with high-flow oxygen before transfer to our hospital for HBO2. All received three HBO2 treatments and 24 hours of TH with a goal temperature of 33 degrees C utilizing the CoolGard 3000 Intravascular Temperature Management System. While in the HBO2 chamber, cooling was maintained with ice bags in the groin, axillae and under the head. Three of the four cases were discharged home with normal neurological exams. One patient sustained severe, diffuse brain injury yet made a dramatic neurological recovery with only minor limitations in higher order memory and attention. No patient left the hospital with other end organ damage including cardiac dysfunction. To our knowledge, these are the first reported cases of the use of both HBO2 and TH to treat severe, acute carbon monoxide poisoning.
authors: Division of Emergency Medicine, David Geffen School of Medicine at University of California at Los Angeles, USA. jofeldman@mednet.ucla.edu
authors: Joanne
authors: J
authors: Feldman
authors: Natasha
authors: N
authors: Renda
authors: Gerald H
authors: GH
authors: Markovitz
authors: Walter
authors: W
authors: Chin
authors: Susan E
authors: SE
authors: Sprau
mesh_terms: D000293:Adolescent; D000328:Adult; D002249:Carbon Monoxide Poisoning / Q000628:therapy*; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D006801:Humans; D006931:Hyperbaric Oxygenation / Q000379:methods*; D007036:Hypothermia, Induced / Q000379:methods*; D008297:Male; D008875:Middle Aged