Characteristics and outcome of children with carbon monoxide poisoning with and without smoke exposure referred for hyperbaric oxygen therapy

Objectives: To describe the clinical characteristics and outcome of childre n with carbon monoxide (CO) poisoning with and without smoke exposure refer red for hyperbaric oxygen therapy (HBOT), and to determine the association between any of these characteristics and death. Setting: Regional hyperbaric referral center, Patients: The medical records of 150 children with CO poisoning (COP) who w ere heated with HBOT between August 92 and September 95 were reviewed, Measurements/Main Results: COP was defined as a history of probable exposur e to CO, with either a carboxyhemoglobin level (COHb) >25, or COHb <25 with neurological, respiratory, or cardiac compromise. Major cutaneous burns we re described as second degree burns over greater than 20% of the patient's total body surface area (TBSA), or third degree burns over greater than 10% of the patient's TBSA. Children extracted from a closed-space fire who had airway soot, singed facial hair/facial burns, or respiratory distress were defined as having smoke inhalation and carbon monoxide poisoning (CO/SI), CO/SI occurred in 40.1% of patients. Compared to children with COP alone, t hose with CO/SI were significantly more likely to have a depressed mental s tatus upon arrival to an ED (76.3% vs 13.6%, P < 0.001), lower mean initial GCS (6.7 vs 14.7, P < 0.001), lower mean initial pH (7.2 vs 7.4, P < 0.001 ), respiratory arrest at the scene (68.5% vs 0%, P < 0.001), and cardiac ar rest at the scene (25.9% vs 0%, P < 0.001), Children with CO/SI were signif icantly more likely to have a poor outcome (death) than children with COP a lone (22.6% vs. 0%, P < 0.001), Comparing children with CO/SI who died vers us survivors, there were significant differences in mean initial COHb (38.3 vs 24.3, P = 0.03), mean initial temperature upon arrival in an ED (94.9 d egrees F vs 98.2 degrees F, P < 0.006), respiratory arrest at the scene (92 % vs 59.6%, P = 0.04), and cardiac arrest at the scene (66.7% vs 13.5%, P < 0.001), Sixty percent of children died who had a combination of risk facto rs of smoke inhalation, low temperature, high COHb level, and respiratory a nd cardiac arrest in the field. Conclusions: These preliminary data suggest that children with COP alone wh o are treated with HBOT are at low risk for dying regardless of initial COH b level. Children with CO/SI have a significantly higher risk of dying than those children with COP alone. A combination of smoke inhalation, low temp erature, high COHb level, respiratory arrest, and cardiac arrest is highly associated with death. Prospective studies are needed to confirm and furthe r define these associations.