Carboxyhemoglobin levels in children during extracorporeal membrane oxygenation support: a retrospective study

Introduction: Hemolysis is a common complication of extracorporeal membrane oxygenation (ECMO). There are few data on whether carboxyhemoglobin (COHb), a potential marker of hemolysis, are elevated during ECMO support. Methods: We conducted a single-center, retrospective study comparing peak COHb levels of children pre-, during, and post-ECMO from January 2017 to August 2020. Results: There were 154 ECMO runs in 147 children (154 PICU admissions) included in the study. The median age was 3.5 (IQR 0.2, 39.2) months. Veno-arterial ECMO was the predominant mode: 146/154 (94.8%). Eighty-seven children (56.5%) underwent cardiac surgery. Peak COHb levels during ECMO were statistically significantly higher compared to pre ECMO (COHb 1.8% (IQR 1.4, 2.6) vs COHb 1.2% (IQR 0.7, 1.7), p < 0.001) and post ECMO (COHb 1.6% (IQR 1.3, 2.2), p = 0.009). Children with COHb ⩾2% were younger and had longer duration of ECMO support. Plasma hemoglobin weakly correlated with COHb level ( r = 0.14; p = 0.04). Conclusions: Carboxyhemoglobin levels increased during ECMO support compared to the pre and post ECMO period. Younger age and longer ECMO duration were associated with COHb levels ⩾2%. Plasma hemoglobin weakly correlated with COHb level.

Toxic Blood Hydrogen Cyanide Concentration as a Vital Sign of a Deceased Room Fire Victim—Case Report

Carbon monoxide (CO) and hydrogen cyanide (HCN) are two common toxic products of combustion. HCN concentrations of fire victims are not routinely determined in most legal medicine services in Romania. We present the case of a room fire victim in which we evaluated the concentrations of HCN and carboxyhemoglobin (COHb), their contribution to the mechanism of death, and the possibility that HCN concentration can be interpreted as vital sign. COHb was determined by spectrophotometry. HCN was spectrophotometrically determined with ninhydrin in postmortem blood samples after its removal with 20% phosphoric acid and uptake into a solution of potassium carbonate. The presence of ethyl alcohol was determined by gas chromatography. The COHb concentration was 6.15%, while the blood HCN concentration was 1.043 µg × mL−1 and the total HCN was 1.904 µg × ml−1. A blood alcohol content of 4.36 g‰ and a urine alcohol content of 5.88 g‰ were also found. Although the fire produced a considerable amount of soot, and there were signs of inhalation of soot particles, the COHb level cannot be interpreted as a vital sign. Toxic concentrations of HCN and total HCN can be interpreted as a vital sign and indicates a contributive effect of HCN in the mechanism of death.

Is endogenous carboxyhemoglobin level a useful biomarker of clinical course and prognosis in COVID-19 patients?

Objective: SARS-CoV-2 has caused nearly 4 million confirmed cases of COVID-19 worldwide in the approximately 4 months since it emerged in Wuhan, China in December 2019. Comorbidities increase morbidity and mortality in COVID-19, and many laboratory parameters have been associated with mortality. The aim of the present study was to identify the relationship between endogenous carboxyhemoglobin (COHb) level and the clinical course and prognosis of COVID-19. Methods: The study included 48 non-smokers or ex-smokers aged 18 years or older who presented to the emergency department, were diagnosed with COVID-19 by real-time PCR analysis of nasopharyngeal swab sample, and were treated in the pulmonary diseases ward of the Atatürk University hospital after between March 24, 2020 and April 15, 2020. The patients’ laboratory parameters and demographic data were analyzed retrospectively. Results: Prothrombin time and C-reactive protein (CRP), troponin-I, and D-dimer levels decreased in COVID-19 patients during follow-up (p=0.024, p=0.001, p=0.001, p=0.001), while PaO2/FiO2 ratio and COHb increased (p=0.002, p=0.001). COHb level at admission was significantly lower in patients who developed macrophage activation syndrome (MAS), acute respiratory distress syndrome (ARDS), and those who died compared to the other patients (p=0.002, p=0.001). COHb level on day 5 of treatment was significantly higher in patients with ARDS and patients who died (p=0.001, p=0.001).Significant correlations were detected between COHb level and CRP (r=-0.425, p=0.001), ferritin (r=-0.395, p=0.001) and PaO2/FiO2 ratio (r=0.431, p=0.001). Conclusions: COHb level may be an easily accessible biomarker that guides early follow-up and treatment planning to avoid ARDS, MAS, and mortality in COVID-19.

Medical Examiner Review of the Characteristics of Fire-Related Homicides

While fire-related deaths are regularly encountered by medical examiners, fire-related homicides are relatively uncommon. Although some large retrospective studies of fire-related deaths have been performed, few large studies have specifically reviewed fire-related homicides. Autopsy, scene investigation, and ancillary studies were reviewed for 38 fire-related homicides evaluated at the Wayne County Medical Examiner’s Office in Detroit, Michigan. The largest proportion of cases were inhalation-related deaths in dwelling fires (n = 21, 55%), followed by deaths from thermal injury after immolation (n = 8, 21%) and traumatic death with contemporaneous or subsequent immolation (n = 8, 21%). There was one case of postmortem immolation. Although carboxyhemoglobin (COHb) levels played a significant role in evaluation of these cases, no single factor was diagnostic of a particular cause or manner of death. Fire-related homicides present unique diagnostic challenges because multiple insults frequently contribute to the cause death. Death at the scene and COHb level above 10% are the most useful factors in establishing smoke and soot inhalation as the cause of death. Some autopsy findings are helpful in establishing or ruling out smoke and soot inhalation as contributing to or sole cause of death, but an evaluation of the entire circumstances and autopsy findings is necessary.

Carbon Monoxide Poisoning Effectively Treated with High-flow Nasal Cannula

Carbon monoxide (CO) poisoning is typically treated by administration of oxygen via non-rebreather mask (NRB). High-flow nasal cannula (HFNC) is an alternative to NRB in a variety of disease states. We report a case of the novel use of HFNC in the treatment of acute CO poisoning. A 29-year-old man presented with a carboxyhemoglobin (COHb) level of 29.8%. He was treated with HFNC, and COHb levels declined to 5.4% in 230 minutes. Given several theoretical advantages of HFNC relative to NRB, HFNC is a potential option for use in the treatment of CO poisoning.

Correlation study of Carbon Monoxide (CO) air exposure level with blood COHb level of Basement Officer in Surabaya Mall

Gas CO is formed as a result of incomplete combustion. The material containing carbon monoxide is gas emission from motorcycle vehicle which is toxic to humans. This study aims to analyze the correlation between CO gas that also known as Carbon monoxide gas in the air with COHb level of blood parking basement officers in Surabaya "x" mall. This study was analytical observational with cross sectional design and the data was analyzed by Chi-Square test. The number of samples used was 15 parking basement officers and a control group of 15 people as a comparison. The results of measurement of CO gas levels in 3 parking points were more than standards recommendation. While the other 3 points in the control area were below the quality standard. All of samples in the parking basement officers had COHb levels >5% and for control areas there were 11 persons who had COHb levels of <5% and 4 people who had COHb levels of >5%. The results suggested that there was a significant correlation between the characteristics of individuals with COHb levels, such as duration of work (p = 0.040), nutritional status (p = 0.047) and smoking habits (p = 0.046). While variable of age (p = 0.070) and personal protective equipment (PPE) use (p = 0.128) showed no significant correlation. In addition, there was a significant correlation between exposure of CO gas and blood COHb levels in basement car park officers in Surabaya “X” Mall (p = 0.000), and there was a distinction between COHb level of blood basement car park officers in the "x" mall building and the control group with a value of p = 0.000. Based on the results, it is suggested for car park officers to cease smoking, go to places with more oxygen, maintain diet and do exercise regularly. It is also suggested and recommended for agencies is to put more attention regarding exhaust fans’ maintenance and sufficiency.

An Evaluation of the Autopsy Cases of Carbon monoxide Poisoning in Trabzon Between 2009-2016

Objective: Carbon monoxide related deaths, which are generally preventable accidents, and more common when compared with other toxic substance consumption, arouse public attention in our country. Materials and Methods: In this study, the aim is to investigate different features of carbon monoxide poisoning related deaths autopsied in Trabzon in 8-year period of time and demonstrate medico-legal aspects of this issue. Results: Our study consists of all deaths due to carbon monoxide poisoning and autopsied by Trabzon Morgue Department of the Council of Forensic Medicine of Turkey between 2009 and 2016. Records of a total of 7133 criminal cases who were autopsied between these years were examined and 215 cases who died due to CO poisoning were evaluated for age, sex, the month of the event occurred, origin, death time, CO source and carboxyhemoglobin (COHb) values. 215 criminal cases were constituting 3.01% of 7133 criminal cases who were autopsied within 8 years in Trabzon. 91 of the cases were (42.3%) female and 124 were (57.7%) male and the male/female case ratio was 1.4. Mean age of the cases was 48.8±27.1years. 24.1% of deaths occurred in January 74% at home. CO source was found to be charcoal in 55.3% of cases. Mean COHb level detected in cases was 54.9±17.6%. Conclusion: Carbon monoxide poisoning is an important social problem in our country as in many developing countries. It is concluded that with their medicolegal experiences and suggestions, forensic medicine specialists can play an important role to manage carbon monoxide poisonings which are mainly...

Identification of CO Exposure, Habits, COHb Blood and Worker’s Health Complaints on Basement Waterplace Apartment, Surabaya

Carbon monoxide (CO) is a silent killer because it is tasteless, colorless, odorless, and causes of death. In the basement, pollution level from vehicle engines combustion is higher than in the ambient air. Workers in the basement potentially expose to CO that trapped while they were working. CO inhaled will form COHb on the blood. This study aims to identify CO exposure, worker habits, COHb blood, and health complaints during their working time in the basement of apartment Waterplace Surabaya. This research was a descriptive with cross-sectional design and used purposive sampling technique with 20 respondents. Data which were collected through observation and interviews. The result showed that CO measurement was below 25 ppm standard. Most characteristics of workers were male (80.0%), 21–29 years old (55.0%), working time for ≤ 12 months (55.0%) and working hours for 12 hours (55.0%). The worker’s habits mostly were smoking (80.0%), regularly consume fruit (55.0%) and vegetables (60.0%). The majority (90.0%) COHb level was above the 3.5% standard. Health worker complaints were dizziness (80.0%), impaired concentration (60.0%) and tired (55.0%) while their working time. Workers that smoking, eating fruits, and vegetables were having a blood COHb levels higher. It was concluded that the levels of CO gas below the standards while blood COHb above the standards. It was suggested to reduce smoking, to start a healthier lifestyle, and to use masker while their working time.