This ACEP Clinical Policy published in Annals of Emergency Medicine looked at the management of patients with suspected Carbon monoxide poisoning. The policy reviewed the literature to answer several questions.
1. In ED patients with suspected acute CO poisoning, can noninvasive COHb measurement be used to accurately diagnose CO toxicity?
Level B recommendations: Do not use noninvasive COHb measurement (pulse CO oximetry) to diagnose CO toxicity in patients with suspected acute CO poisoning.
Potential Benefit of Implementing the Recommendations: In patients with suspected CO poisoning, implementing this recommendation can help emergency physicians to reduce diagnostic error caused by relying on the use of noninvasive COHb testing.Potential Harm of Implementing the Recommendations: The subcommittee identified no potential harms of implementing this recommendation.
2. In ED patients diagnosed with acute CO poisoning, does HBO2 therapy as compared with normobaric oxygen therapy improve long-term neurocognitive outcomes?
Level B recommendations: Emergency physicians should use HBO2 therapy or high-flow normobaric therapy for acute CO-poisoned patients. It remains unclear whether HBO2 therapy is superior to normobaric oxygen therapy for improving long-term neurocognitive outcomes.
Potential Benefit of Implementing the Recommendations: Given the inconclusiveness of the data (some trials showing benefit, some showing no benefit or harm), this recommendation may help provide support for emergency physicians who choose not to refer patients for HBO2 therapy, especially when there are time, financial, or geographic constraints.Potential Harm of Implementing the Recommendations: Based on review of the available research to date, the subcommittee identified no potential harms in implementing this recommendation.
3. In ED patients diagnosed with acute CO poisoning, can cardiac testing be used to predict morbidity or mortality?
Level B recommendations: In ED patients with moderate to severe CO poisoning, obtain an ECG and cardiac biomarker levels to identify acute myocardial injury, which can predict poor outcome.
Potential Benefit of Implementing the Recommendations: The benefits of implementing this recommendation may include improved risk stratification and identification of CO-poisoned patients at significant risk for cardiac morbidity and mortality.Potential Harm of Implementing the Recommendations: The identification of acute myocardial injury may result in unnecessary future cardiac testing and monitoring that may not improve patient-centered outcomes.