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.

Mass-casualty Response to the Kiss Nightclub in Santa Maria, Brazil.

On January 27, 2013, a fire at the Kiss Nightclub in Santa Maria, Brazil led to a mass-casualty incident affecting hundreds of college students. A total of 234 people died on scene, 145 were hospitalized, and another 623 people received treatment throughout the first week following the incident.1 Eight of the hospitalized people later died.1 The Military Police were the first on scene, followed by the state fire department, and then the municipal Mobile Prehospital Assistance (SAMU) ambulances. The number of victims was not communicated clearly to the various units arriving on scene, leading to insufficient rescue personnel and equipment. Incident command was established on scene, but the rescuers and police were still unable to control the chaos of multiple bystanders attempting to assist in the rescue efforts. The Municipal Sports Center (CDM) was designated as the location for dead bodies, where victim identification and communication with families occurred, as well as forensic evaluation, which determined the primary cause of death to be asphyxia. A command center was established at the Hospital de Caridade Astrogildo de Azevedo (HCAA) in Santa Maria to direct where patients should be admitted, recruit staff, and procure additional supplies, as needed. The victims suffered primarily from smoke inhalation and many required endotracheal intubation and mechanical ventilation. There was a shortage of ventilators; therefore, some had to be borrowed from local hospitals, neighboring cities, and distant areas in the state. A total of 54 patients1 were transferred to hospitals in the capital city of Porto Alegre (Brazil). The main issues with the response to the fire were scene control and communication. Areas for improvement were identified, namely the establishment of a disaster-response plan, as well as regularly scheduled training in disaster preparedness/response. These activities are the first steps to improving mass-casualty responses.

The risk of dying on days of higher air pollution among the socially disadvantaged elderly.

RATIONALE: The estimated mortality rate associated with ambient air pollution based on general population studies may not be applicable to certain subgroups. OBJECTIVE: The objective of the present study was to determine the influence of age, education, employment status and income on the risk of mortality associated with ambient air pollution. METHODS: Daily time-series analyses tested the association between daily air pollution and daily mortality in seven Chilean urban centers during the period January 1997-December 2007. Results were adjusted for long-term trends, day-of-the week and humidex. RESULTS: Interquartile increases in particulate matter (PM(10) and PM(2.5)), sulphur dioxide, nitrogen dioxide, carbon monoxide, and elemental and organic carbon were associated with a 4-7% increase in mortality among those who did not complete primary school (p<0.05) vs. 0.5-1.5% among university graduates (p>0.05). Among those at least 85 years of age respective estimates were 2-7%. However, among the elderly who did not complete primary school, respective estimates were 11-19% (p<0.05). The degree of effect modification was less for income and employment status than education, and sex did not modify the results. CONCLUSION: The socially disadvantaged, especially if elderly appear to be especially susceptible to dying on days of higher air pollution. Concentrations deemed acceptable for the general population would not appear to protect this susceptible subgroup.

Consideraciones estadístico-epidemiológicas sobre las muertes producidas por monóxido de carbono en la Ciudad Autónoma de Buenos Aires: experiencia de la Morgue Judicial del Poder Judicial de la Nación durante el decenio 1997-2007 / Some statistical-epidemiological considerations related to deaths due to carbon monoxide in the city of Buenos Aires During the decade 1997-2007

Carbon monoxide (CO) intoxication is the most common cause of death after acute smoke inhalation and may be the most common inhalation toxin overall. The central nervous system and heart are especially vulnerable to CO intoxication. The risk of acute and long-term neurologic effects unders-cores the importance of prompt treatment with high concentration of supplemental oxygen. The authors of this report present some statistical and epidemilogical considerations related to deaths due to carbon monoxide in the City of Buenos Aires. This is an experience of the Judicial Morgue during the decade between the years 1997 and 2007.

Consideraciones estadístico-epidemiológicas sobre las muertes producidas por monóxido de carbono en la Ciudad Autónoma de Buenos Aires: experiencia de la Morgue Judicial del Poder Judicial de la Nación durante el decenio 1997-2007 / Some statistical-epidemiological considerations related to deaths due to carbon monoxide in the city of Buenos Aires During the decade 1997-2007

Carbon monoxide (CO) intoxication is the most common cause of death after acute smoke inhalation and may be the most common inhalation toxin overall. The central nervous system and heart are especially vulnerable to CO intoxication. The risk of acute and long-term neurologic effects unders-cores the importance of prompt treatment with high concentration of supplemental oxygen. The authors of this report present some statistical and epidemilogical considerations related to deaths due to carbon monoxide in the City of Buenos Aires. This is an experience of the Judicial Morgue during the decade between the years 1997 and 2007.(AU)

Some usual and unusual poisonings due to carbon monoxide

Carbon monoxide poisoning is a frequent occurrence in both developed and under developed countries of the world. Carbon monoxide can be produced in fires, automobile engine exhausts and the incomplete combustion of organic matter. It is a [quot ]silent killer[quot ] that initially produces a mild progressive frontal headache, drowsiness and sleep that is usually ignored as common place. Continued low-level CO exposure for a long period of time in a confined space is cumulative and these accidental deaths are frequent but should be avoidable. Several usual and unusual poisonings are reported to illustrate its various forms of exposure. It all began many years ago when a bolt of lightening hit a fallen tree and produced a fire. Early cave man later learned to enjoy some of the benefits of this new discovery. They could now see at night, they could keep warm, keep the predators at bay, cook their food and make it taste better and be more gentle to their teeth. Also meat could be preserved and eaten at a later date especially if it were dried and smoked. They learned by trial and error that it was dangerous to bring their fire deep into their cave without a chimney. Carbon monoxide (CO) also can be easily produced by many other sources besides fire. Very common today is the incomplete combustion of gasoline in the engine of an automobile which can produce about 6 carbon monoxide

Some usual and unusual poisonings due to carbon monoxide.

Carbon monoxide poisoning is a frequent occurrence in both developed and under developed countries of the world. Carbon monoxide can be produced in fires, automobile engine exhausts and the incomplete combustion of organic matter. It is a "silent killer" that initially produces a mild progressive frontal headache, drowsiness and sleep that is usually ignored as common place. Continued low-level CO exposure for a long period of time in a confined space is cumulative and these accidental deaths are frequent but should be avoidable. Several usual and unusual poisonings are reported to illustrate its various forms of exposure. It all began many years ago when a bolt of lightening hit a fallen tree and produced a fire. Early cave man later learned to enjoy some of the benefits of this new discovery. They could now see at night, they could keep warm, keep the predators at bay, cook their food and make it taste better and be more gentle to their teeth. Also meat could be preserved and eaten at a later date especially if it were dried and smoked. They learned by trial and error that it was dangerous to bring their fire deep into their cave without a chimney. Carbon monoxide (CO) also can be easily produced by many other sources besides fire. Very common today is the incomplete combustion of gasoline in the engine of an automobile which can produce about 6% carbon monoxide.

Deaths from motor-vehicle-related unintentional carbon monoxide poisoning--Colorado, 1996, New Mexico, 1980-1995, and United States, 1979-1992.

Carbon monoxide (CO) is a colorless, odorless, toxic gas that is a product of incomplete combustion. Motor vehicles, heaters, and appliances that use carbon-based fuels are the main sources of this poison. Most fatal unintentional CO poisonings associated with motor vehicles are preventable and can result from differing mechanisms of exposure; 1) operation of a motor vehicle with a damaged or malfunctioning exhaust system and an inadequately ventilated passenger compartment, 2) operation of a motor vehicle in an enclosed space (e.g., a garage) with inadequate ventilation, and 3) use of auxiliary fuel-burning heaters inside a passenger compartment or in a camper. This report describes the investigation of deaths associated with multiple motor-vehicle-related CO poisonings in Colorado on November 3, 1996, summarizes a review of such deaths in New Mexico during 1980-1995, and presents geographic and seasonal patterns in national death rates for 1979-1992. These findings indicate that deaths from motor-vehicle-related unintentional CO poisonings increase during winter months and that death rates from CO poisoning in stationary motor vehicles are highest in states with colder average winter temperatures.

Unintentional deaths from carbon monoxide poisoning in New Mexico, 1980 to 1988. A comparison of medical examiner and national mortality data.

Carbon monoxide was the number 1 cause of poisoning deaths in the United States from 1980 through 1988, with the highest rates reported in the western states. We studied unintentional deaths from carbon monoxide poisoning in New Mexico during this period using the multiple-cause mortality files from the National Center for Health Statistics (NCHS) and data from the New Mexico Office of the Medical Investigator (OMI). We compared the nationally available NCHS data with the more detailed OMI data to determine the sensitivity of NCHS data for the surveillance of this preventable cause of death. The NCHS data were 88% sensitive in identifying deaths from unintentional carbon monoxide poisoning and had a positive predictive value of 81% when compared with OMI data. Half of the unintentional carbon monoxide-related deaths were attributable to a home heating mechanism of some sort, 46% involved motor vehicle exhaust, and at least 42% were associated with alcohol use. We conclude that available NCHS data are a sensitive source of surveillance information about unintentional deaths from carbon monoxide poisoning. Additional details about specific deaths can be obtained from medical examiner files when needed.