Chest radiograph showed bilateral air space opacities. Brain computed tomography was negative for intracranial pathology or cerebral edema. The baseline blood count, chemistry profile, liver function test, and electrocardiography were normal. A urine drug screen, human immunodeficiency virus, alcohol, and salicylate levels were negative. Laboratory results revealed severe anion gap metabolic acidosis with a serum lactate level of 7.6 mmol/L and a carboxyhemoglobin level of 13.6% (∼2–4 h after being placed on F IO 2 of 1.0). Her initial vital signs showed a heart rate of 134 beats/min and blood pressure of 87/54 mm Hg. The duration and intensity of CO exposure were not known, but the patient's husband was found dead in the same vehicle, and witnesses described them as having good health 10 h before discovery. She was emergently intubated, treated with oxygen (F IO 2 of 1.0), and transferred to a tertiary center for suspected CO poisoning associated with malfunction of the vehicle's exhaust system. We present a patient who developed multiple-organ failure associated with CO poisoning and who was successfully supported with venoarterial extracorporeal membrane oxygenation (ECMO).Ī previously healthy 38-y-old woman was found unresponsive in a recreational vehicle while camping in the fall. 3 Treatment of CO poisoning is mainly supportive, and supplemental oxygen remains the cornerstone of therapy, whereas hyperbaric oxygen therapy is considered for patients with evidence of neurological and myocardial injury. 2 CO also binds to myocardial myoglobin, preventing oxidative phosphorylation in cardiac mitochondria and resulting in cardiac ischemia or stunning and cardiogenic pulmonary edema. CO rapidly binds to hemoglobin to form carboxyhemoglobin, leading to tissue hypoxia, multiple-organ failure, and cardiovascular collapse. 1 CO is a tasteless and odorless poisonous gas produced from incomplete combustion of hydrocarbons, and it is found in combustion fumes, such as those produced by cars and trucks, small gasoline engines, stoves, lanterns, burning charcoal and wood, gas ranges, and heating systems. We report the successful use of venoarterial ECMO in a patient with severe CO poisoning and multiple-organ failure.Ĭarbon monoxide (CO) is the most common cause of poisoning and poisoning-related death, resulting in > 20,000 emergency department visits and ∼450 fatalities each year in the United States. Extracorporeal membrane oxygenation (ECMO) has been utilized effectively in patients with respiratory failure and hemodynamic instability, but its use has rarely been reported in patients with CO poisoning. Treatment of CO poisoning is mainly supportive, and supplemental oxygen remains the cornerstone of therapy, whereas hyperbaric oxygen therapy is considered for patients with evidence of neurological and myocardial injury. CO also binds to myocardial myoglobin, preventing oxidative phosphorylation in cardiac mitochondria and resulting in cardiac ischemia or stunning and cardiogenic pulmonary edema. It is a tasteless and odorless poisonous gas produced from incomplete combustion of hydrocarbons, such as those produced by cars and heating systems. Therefore, carbon dioxide poisoning is a rare but not to miss diagnosis in the emergency department.Ĭarbon dioxide Carbon dioxide intoxication Dry ice Intoxication.Carbon monoxide (CO) is the most common cause of poisoning and poisoning-related death in the United States. Without adequate treatment, victims may show acute reduced cognitive performance, respiratory failure, and circulatory arrest. When confronted with a victim, he/she should be removed from the dangerous area as fast as possible and oxygen should be administered. Pre-hospital responders also need to pay attention for the possible diagnosis of CO 2 intoxication for their own safety. Our review suggested that precautions are needed when handling dry ice or while working in confined spaces. Mechanisms of carbon dioxide poising (both as an asphyxiant and as a toxicant) were described. Studies related to decompression sickness were excluded. Articles were included based on their focus on medical or physiological effects of carbon dioxide. The goal of this article was to provide an overview of the literature available on carbon dioxide intoxication.
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