Effect of ethanol in carbon monoxide poisoning and delayed neurologic sequelae: A prospective observational study

Objectives Carbon monoxide (CO) is one of the most common poisoning substances, which causes mortality and morbidity worldwide. Delayed neurologic sequelae (DNS) have been reported to occur from several days to months after exposure to CO. Thus, there is a need for prevention, recognition, and treatment of DNS. Patients with CO poisoning as a component of intentional suicide often also consume ethanol, but there is debate regarding its role in DNS. We explored whether ethanol has a neuroprotective effect in CO poisoning. Methods This prospective observational study included patients who visited the emergency department from August 2016 to August 2019 due to CO poisoning. After treatment of acute CO poisoning, patients were interviewed by telephone to ascertain whether DNS had occurred within 2 weeks, 1 month, and 3 months from the time of CO exposure. Results During the study period, 171 patients were enrolled. 28 patients (16.37%) developed DNS. The initial Glasgow Coma Scale (GCS) scores were 15 (10.5–15) for the non-DNS group and 10 (7–15) for the DNS group (p = 0.002). The ethanol levels were 11.01 ± 17.58 mg/dL and 1.49 ± 2.63 mg/dL for each group (p < 0.001). In multivariate logistic regression analysis, the GCS score had an odds ratio of 0.770 (p < 0.001) and the ethanol level had 0.882 (p < 0.030) for onset of DNS. Conclusions Higher ethanol level and higher initial GCS score were associated with lower incidence of DNS. Ethanol could have a neuroprotective effect on the occurrence of DNS in CO poisoning patients.

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Variability in Treatment for Carbon Monoxide Poisoning in Japan: A Multicenter Retrospective Survey

Emergency Medicine International ◽

10.1155/2018/2159147 ◽

2018 ◽

Vol 2018 ◽

pp. 1-5

Author(s):

Motoki Fujita ◽

Yasutaka Oda ◽

Kotaro Kaneda ◽

Yoshikatsu Kawamura ◽

Takashi Nakahara ◽

...

Keyword(s):

Carbon Monoxide ◽

Observational Study ◽

Online Survey ◽

Prospective Observational Study ◽

Carbon Monoxide Poisoning ◽

Co Poisoning ◽

Neurological Sequelae ◽

Retrospective Survey ◽

Consciousness Disturbance ◽

Long Time

Background. The aim of this study was to identify practice differences in the treatment of carbon monoxide (CO) poisoning with or without hyperbaric oxygen (HBO2) therapy in Japan. Materials and Methods. Using an online survey website (Google form), we created a questionnaire and invited interested institutions to join the COP-J Study, a prospective observational study of CO poisoning in Japan. Results. Forty-eight (63%) of 76 institutions replied to the questionnaire. Thirty-three institutions (69%) administered HBO2 therapy to patients with CO poisoning, and 15 institutions (31%) did not. Consciousness disturbance on arrival, exposure to CO for a long time, and elevation of arterial carboxyhemoglobin (CO-Hb) were the major indications for HBO2 therapy. The maximum therapeutic pressures were 2.0, 2.5, and 2.8 atmospheres absolute (ATA) at 19 (58%), 6 (18%), and 8 (24%) institutions, respectively. The number of HBO2 sessions on the first day was 1–3, and 1–7 sessions were administered on days 2–7. Seventeen (35%) institutions treated patients with delayed neurological sequelae (DNS) and 15 of them used HBO2 therapy for DNS. Conclusions. This survey indicates that HBO2 therapy for CO poisoning was varied in both the indications and practice regimens used in Japan.

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Use of hyperbaric oxygen therapy for preventing delayed neurological sequelae in patients with carbon monoxide poisoning: A multicenter, prospective, observational study in Japan

PLoS ONE ◽

10.1371/journal.pone.0253602 ◽

2021 ◽

Vol 16 (6) ◽

pp. e0253602

Author(s):

Motoki Fujita ◽

Masaki Todani ◽

Kotaro Kaneda ◽

Shinya Suzuki ◽

Shinjiro Wakai ◽

...

Keyword(s):

Carbon Monoxide ◽

Observational Study ◽

Hyperbaric Oxygen ◽

Prospective Observational Study ◽

Carbon Monoxide Poisoning ◽

Clinical Treatment ◽

Co Poisoning ◽

Neurological Sequelae ◽

Factors Associated ◽

Multicenter Prospective Observational Study

Background The purpose of this study was to clarify the practical clinical treatment for acute carbon monoxide (CO) poisoning in Japan and to investigate the efficacy of hyperbaric oxygen (HBO2) therapy in preventing delayed neurological sequelae (DNS) in the acute phase of CO poisoning. Methods We conducted a multicenter, prospective, observational study of acute CO poisoning in Japan. Patients with acute CO poisoning were enrolled and their treatment details were recorded. The primary endpoint was the onset of DNS within 2 months of CO exposure. Factors associated with DNS were assessed with logistic regression analysis. Results A total of 311 patients from 57 institutions were registered and 255 were analyzed: 171 received HBO2 therapy (HBO2 group) and 84 did not (normobaric oxygen [NBO2] group). HBO2 therapy was performed zero, once, twice, or three times within the first 24 h in 1.8%, 55.9%, 30.9%, and 11.3% of the HBO2 group, respectively. The treatment pressure in the first HBO2 session was 2.8 ATA (47.9% of the HBO2 group), 2.0 ATA (41.8%), 2.5 ATA (7.9%), or another pressure (2.4%). The incidence of DNS was 13/171 (7.6%) in the HBO2 group and 3/84 (3.6%) in the NBO2 group (P = 0.212). The number of HBO2 sessions in the first 24 h was one of the factors associated with the incidence of DNS (odds ratio, 2.082; 95% confidence interval, 1.101–3.937; P = 0.024). Conclusions The practical clinical treatment for acute CO poisoning, including HBO2 therapy, varied among the institutions participating in Japan. HBO2 therapy with inconsistent protocols showed no advantage over NBO2 therapy in preventing DNS. Multiple HBO2 sessions was associated with the incidence of DNS.

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Cox regression model of prognostic factors for delayed neuropsychiatric sequelae in patients with acute carbon monoxide poisoning: A prospective observational study

NeuroToxicology ◽

10.1016/j.neuro.2020.11.006 ◽

2021 ◽

Vol 82 ◽

pp. 63-68

Author(s):

Sangsoo Han ◽

Sungwoo Choi ◽

Sangun Nah ◽

Sun-Uk Lee ◽

Young Soon Cho ◽

...

Keyword(s):

Carbon Monoxide ◽

Prognostic Factors ◽

Observational Study ◽

Regression Model ◽

Prospective Observational Study ◽

Cox Regression ◽

Carbon Monoxide Poisoning ◽

Cox Regression Model ◽

Acute Carbon Monoxide Poisoning ◽

Delayed Neuropsychiatric Sequelae

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Selective Susceptibility of Oligodendrocytes to Carbon Monoxide Poisoning: Implication for Delayed Neurologic Sequelae (DNS)

Frontiers in Psychiatry ◽

10.3389/fpsyt.2020.00815 ◽

2020 ◽

Vol 11 ◽

Author(s):

Xiaofei Tian ◽

Teng Guan ◽

Ying Guo ◽

Guohui Zhang ◽

Jiming Kong

Keyword(s):

Carbon Monoxide ◽

Carbon Monoxide Poisoning ◽

Neurologic Sequelae ◽

Delayed Neurologic Sequelae

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Prognostic factors of carbon monoxide poisoning in Taiwan: a retrospective observational study

BMJ Open ◽

10.1136/bmjopen-2019-031135 ◽

2019 ◽

Vol 9 (11) ◽

pp. e031135 ◽

Cited By ~ 1

Author(s):

Ke-Ting Pan ◽

Chih-Hao Shen ◽

Fu-Gong Lin ◽

Yu-Ching Chou ◽

Ben Croxford ◽

...

Keyword(s):

Carbon Monoxide ◽

Logistic Regression ◽

Prognostic Factors ◽

Observational Study ◽

General Hospital ◽

Roc Curve ◽

Carbon Monoxide Poisoning ◽

Retrospective Observational Study ◽

Poor Outcomes ◽

Gcs Score

ObjectivesTo identify the risk factors related to the prognosis of carbon monoxide (CO)-poisoned patients in the hospital.DesignRetrospective observational study.SettingTri-Service General Hospital, Taiwan.MethodsWe conducted a review of the medical records of 669 CO-poisoned patients, who were admitted to the Department of Emergency, Tri-Service General Hospital, Taiwan, from 2009 to 2014. Demographic, clinical and laboratory data were collected for analysis. In the study, the end points for poor outcome were patients who either still had sequelae, were bedridden or died after treatment. The independent t-test, χ2 test and binary logistic regression were used to identify the association between the prognostic factors and the outcomes.ResultsThe logistic regression analysis confirmed that the Glasgow Coma Scale (GCS) score (p=0.008) and blood urea nitrogen (BUN) (p=0.002) were related to poor outcomes. Furthermore, the receiver operating characteristic (ROC) curve showed that the cut-off point of intubation days was 1.5 days (area under the ROC curve [AUC]=0.793) for all patients and 2.5 days (AUC=0.817) for patients with intubation when predicting poor outcomes.ConclusionWe identified the factors that most strongly predict the prognosis of CO poisoning, including the GCS score, serum BUN and intubation days. Moreover, the number of hyperbaric oxygen treatments seems to have impact of the outcome.

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