Clinical Outcomes and Mortality Impact of Hyperbaric Oxygen Therapy in Patients With Carbon Monoxide Poisoning

Objectives: Carbon monoxide poisoning affects 50,000 per year in the United States alone. Mortality is approximately 3%, and up to 40% of survivors suffer from permanent neurocognitive and affective deficits. Hyperbaric oxygen therapy has shown benefit on reducing the long-term neurologic sequelae of carbon monoxide poisoning but has not demonstrated improved survival. The objective of this study is to assess the efficacy of hyperbaric oxygen for acute and long-term mortality in carbon monoxide poisoning using a large clinical databank. Design: Retrospective analysis. Setting: University of Pittsburgh Medical Center healthcare system (Pittsburgh, PA). Patients: One-thousand ninety-nine unique encounters of adult patients with carbon monoxide poisoning. Interventions: None. Measurements and Main Results: Baseline demographics, laboratory values, hospital charge transactions, discharge disposition, and clinical information from charting were obtained from the electronic medical record. In propensity-adjusted analysis, hyperbaric oxygen therapy was associated with a reduction in inpatient mortality (absolute risk reduction, 2.1% [3.7–0.9%]; p = 0.001) and a reduction in 1-year mortality (absolute risk reduction, 2.1% [3.8–0.4%]; p = 0.013). Conclusions: These data demonstrate that hyperbaric oxygen is associated with reduced acute and reduced 1-year mortality. Further studies are needed on the mortality effects of hyperbaric oxygen therapy in carbon monoxide poisoning. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (https://ift.tt/29S62lw). Dr. Rose disclosed that he and Dr. Gladwin are shareholders in Globin Solutions and are coinventors of provisional and pending patents for the use of recombinant neuroglobin and heme-based molecules as antidotes for carbon monoxide poisoning. Globin Solutions, Inc. has licensed this technology. Dr Rose is an officer and director of Globin Solutions, Inc. Dr Gladwin is a director and advisor of Globin Solutions, Inc. Dr. Gladwin is a coinventor on patents directed to the use of nitrite salts in cardiovascular diseases and is a coinvestigator in a research collaboration with Bayer Pharmaceuticals to evaluate riociguate as a treatment for patients with sickle cell disease. Drs. Rose and Gladwin received support for article research from the National Institutes of Health. Dr. Rose also received support for article research from the Francis Family Foundation. The remaining authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: gladwinmt@upmc.edu Copyright © by 2018 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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