Regional hyperbaric referral center.
PATIENTS: COP was defined as a history of probable exposure to CO, with either a
carboxyhemoglobin level (COHb) > 25, or COHb < 25 with neurological, respiratory, or cardiac compromise. Major cutaneous
burns were 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, those with CO/SI were significantly more likely to have a depressed mental status 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 arrest at the scene (25.9% vs 0%, P < 0.001). Children with CO/SI were significantly more likely to have a poor outcome (death) than children with COP alone (22.6% vs. 0%, P < 0.001). Comparing children with CO/SI who died versus 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 degrees F vs 98.2 degrees, 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 factors of
smoke inhalation, low temperature, high COHb level, and respiratory and
cardiac arrest in the field.
CONCLUSIONS: These preliminary data suggest that children with COP alone who are treated with HBOT are at low risk for dying regardless of initial COHb level. Children with CO/SI have a significantly higher risk of dying than those children with COP alone. A combination of
smoke inhalation, low temperature, high COHb level, respiratory arrest, and
cardiac arrest is highly associated with death. Prospective studies are needed to confirm and further define these associations.