Comparison of hyperbaric oxygen therapy pressures for acute carbon monoxide poisoning

Abstract

Purpose: No consensus currently exists regarding the maximal pressure of hyperbaric oxygen (HBO<sub>2</sub>) therapy performed within 24 hours of acute carbon monoxide (CO) poisoning. This study aimed to evaluate the difference in therapeutic effects according to the first HBO<sub>2</sub> pressure (3.0 atmospheres absolute [ATA] vs. 2.8 ATA).Methods: We used prospectively collected registry data on CO poisoning at a tertiary academic hospital in the Republic of Korea. Adult patients with acute CO poisoning treated with HBO<sub>2</sub> within 24 hours after arrival at the emergency department and without the use of additional HBO<sub>2</sub> after 24 hours between January 2007 and February 2022 were included. Data from 595 patients were analyzed using propensity score matching (PSM). Patients with mild (non-intubated) and severe (intubated) poisoning were also compared. Neurocognitive outcomes at 1 month after CO poisoning were evaluated using the Global Deterioration Scale combined with neurological impairment.Results: After PSM, the neurocognitive outcomes at 1-month post-CO exposure were not significantly different between the 2.8 ATA (110 patients) and 3.0 ATA (55 patients) groups (<i>p</i>=1.000). Similarly, there was also no significant difference in outcomes in a subgroup analysis according to poisoning severity in matched patients (165 patients) (mild [non-intubated]: <i>p</i>=0.053; severe [intubated]: <i>p</i>=1.000).Conclusion: Neurocognitive sequelae at 1 month were not significantly different between HBO<sub>2</sub> therapy pressures of 2.8 ATA and 3.0 ATA in patients with acute CO poisoning. In addition, the 1-month neurocognitive sequelae did not differ significantly between intubated and non-intubated patients.