Weaver LK, Hopkins RO, Chan KJ, Churchill S, Elliott CG, Clemmer TP, Orme JF Jr, Thomas FO, Morris AH, et al.
The New England journal of medicine. Date of publication 2002 Oct 3;volume 347(14):1057-67.
1. N Engl J Med. 2002 Oct 3;347(14):1057-67.
Hyperbaric oxygen for acute carbon monoxide poisoning.
Weaver LK(1), Hopkins RO, Chan KJ, Churchill S, Elliott CG, Clemmer TP, Orme JF
Jr, Thomas FO, Morris AH.
Author information:
(1)Department of Internal Medicine, Pulmonary and Critical Care Division, LDS
Hospital, Salt Lake City, Utah 84143, USA. lweaver@ihc.com
Comment in
N Engl J Med. 2002 Oct 3;347(14):1105-6.
N Engl J Med. 2003 Feb 6;348(6):557-60; author reply 557-60.
ACP J Club. 2003 May-Jun;138(3):67.
N Engl J Med. 2003 Feb 6;348(6):557-60; author reply 557-60.
N Engl J Med. 2002 Oct 3;347(14):1054-5.
N Engl J Med. 2003 Feb 6;348(6):557-60; author reply 557-60.
N Engl J Med. 2003 Feb 6;348(6):557-60; author reply 557-60.
N Engl J Med. 2003 Feb 6;348(6):557-60; author reply 557-60.
BACKGROUND: Patients with acute carbon monoxide poisoning commonly have cognitive
sequelae. We conducted a double-blind, randomized trial to evaluate the effect of
hyperbaric-oxygen treatment on such cognitive sequelae.
METHODS: We randomly assigned patients with symptomatic acute carbon monoxide
poisoning in equal proportions to three chamber sessions within a 24-hour period,
consisting of either three hyperbaric-oxygen treatments or one normobaric-oxygen
treatment plus two sessions of exposure to normobaric room air. Oxygen treatments
were administered from a high-flow reservoir through a face mask that prevented
rebreathing or by endotracheal tube. Neuropsychological tests were administered
immediately after chamber sessions 1 and 3, and 2 weeks, 6 weeks, 6 months, and
12 months after enrollment. The primary outcome was cognitive sequelae six weeks
after carbon monoxide poisoning.
RESULTS: The trial was stopped after the third of four scheduled interim
analyses, at which point there were 76 patients in each group. Cognitive sequelae
at six weeks were less frequent in the hyperbaric-oxygen group (19 of 76 [25.0
percent]) than in the normobaric-oxygen group (35 of 76 [46.1 percent], P=0.007),
even after adjustment for cerebellar dysfunction and for stratification variables
(adjusted odds ratio, 0.45 [95 percent confidence interval, 0.22 to 0.92];
P=0.03). The presence of cerebellar dysfunction before treatment was associated
with the occurrence of cognitive sequelae (odds ratio, 5.71 [95 percent
confidence interval, 1.69 to 19.31]; P=0.005) and was more frequent in the
normobaric-oxygen group (15 percent vs. 4 percent, P=0.03). Cognitive sequelae
were less frequent in the hyperbaric-oxygen group at 12 months, according to the
intention-to-treat analysis (P=0.04).
CONCLUSIONS: Three hyperbaric-oxygen treatments within a 24-hour period appeared
to reduce the risk of cognitive sequelae 6 weeks and 12 months after acute carbon
monoxide poisoning.
Copyright 2002 Massachusetts Medical Society
DOI: 10.1056/NEJMoa013121
PMID: 12362006 [Indexed for MEDLINE]
