Carbon Monoxide Poisoning (Reprinted from the 2023 Hyperbaric Indications Manual 15^th edition)

Area of Science:

• Toxicology
• Emergency Medicine
• Neurology

Background:

• Carbon monoxide (CO) poisoning affects 50,000 people annually in the US, leading to emergency visits.
• Exposure can be acute and lethal or chronic and sub-lethal, causing diverse symptoms including neurological deficits.
• CO poisoning frequently results in brain injury affecting cognition, affect, neurological, and somatic functions.

Purpose of the Study:

• To review the efficacy of hyperbaric oxygen therapy (HBOT) in treating carbon monoxide poisoning.
• To highlight the mechanisms by which HBOT mitigates CO-induced damage.
• To recommend HBOT for symptomatic CO poisoning cases.

Main Methods:

• Review of existing randomized clinical trials in humans and animal studies on HBOT for CO poisoning.
• Analysis of HBOT's physiological effects on carboxyhemoglobin elimination and inflammatory processes.
• Evaluation of HBOT's impact on mitochondrial function and neuroinflammation.

Main Results:

• Hyperbaric oxygen (HBO2) hastens carboxyhemoglobin (COHb) elimination more effectively than normobaric oxygen.
• HBO2 modulates inflammatory processes, improves mitochondrial function, and reduces brain inflammation.
• Evidence supports HBOT's benefit in cases of CO poisoning, especially when complicated by cyanide poisoning or smoke inhalation.

Conclusions:

• Hyperbaric oxygen therapy should be considered for all cases of acute symptomatic CO poisoning.
• HBOT offers significant advantages over standard oxygen therapy in mitigating CO-induced neurological damage.
• The therapeutic benefits of HBOT are supported by robust clinical and preclinical evidence.