Treatment of carbon monoxide poisoning with hyperbaric oxygen and therapeutic hypothermia.

TL;DRAbstract

We present a preliminary case report series of severe, acute carbon monoxide poisoning in which both hyperbaric oxygen (HBO2) and therapeutic hypothermia (TH) were used to ameliorate neurological sequelae. Carbon monoxide poisoning is a standard indication for HBO2. While typically used postcardiac arrest, TH has been used for other types of hypoxic-ischemic brain injury. Four patients were found comatose from carbon monoxide exposure. They were intubated and treated with high-flow oxygen before transfer to our hospital for HBO2. All received three HBO2 treatments and 24 hours of TH with a goal temperature of 33 degrees C utilizing the CoolGard 3000 Intravascular Temperature Management System. While in the HBO2 chamber, cooling was maintained with ice bags in the groin, axillae and under the head. Three of the four cases were discharged home with normal neurological exams. One patient sustained severe, diffuse brain injury yet made a dramatic neurological recovery with only minor limit

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