Hyperbaric Oxygen Therapy for Acute Carbon Monoxide Poisoning: Comparative Clinical Effectiveness and Guidelines

TITLE: Hyperbaric Oxygen Therapy for Acute Carbon Monoxide Poisoning: Comparative Clinical Effectiveness and Guidelines

DATE: 20 March 2015

RESEARCH QUESTIONS

1. What is the comparative clinical effectiveness of hyperbaric oxygen therapy versus normobaric oxygen therapy for the treatment of acute carbon monoxide poisoning in adults?

2. What are the evidence-based guidelines regarding the treatment of acute carbon monoxide poisoning in adults?

KEY FINDINGS

Two systematic reviews, one randomized controlled trial, and one non-randomized study were identified regarding the comparative clinical effectiveness of hyperbaric oxygen therapy versus normobaric oxygen therapy for the treatment of acute carbon monoxide poisoning in adults.

METHODS

A limited literature search was conducted on key resources including PubMed, The Cochrane Library (2015, Issue 3), University of York Centre for Reviews and Dissemination (CRD) databases, ECRI, Canadian and major international health technology agencies, as well as a focused Internet search. No filters were applied to limit the retrieval by study type. Where possible, retrieval was limited to the human population. The search was also limited to English language documents published between January 1, 2010 and March 13, 2015. Internet links were provided, where available.

SELECTION CRITERIA

One reviewer screened citations and selected studies based on the inclusion criteria presented in Table 1.

Disclaimer: The Rapid Response Service is an information service for those involved in planning and providing health care in Canada. Rapid responses are based on a limited literature search and are not comprehensive, systematic reviews. The intent is to provide a list of sources of the best evidence on the topic that CADTH could identify using all reasonable efforts within the time allowed. Rapid responses should be considered along with other types of information and health care considerations. The information included in this response is not intended to replace professional medical advice, nor should it be construed as a recommendation for or against the use of a particular health technology. Readers are also cautioned that a lack of good quality evidence does not necessarily mean a lack of effectiveness particularly in the case of new and emerging health technologies, for which little information can be found, but which may in future prove to be effective. While CADTH has taken care in the preparation of the report to ensure that its contents are accurate, complete and up to date, CADTH does not make any guarantee to that effect. CADTH is not liable for any loss or damages resulting from use of the information in the report.

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Table 1: Selection Criteria Population Adults with acute carbon monoxide poisoning Intervention Hyperbaric oxygen therapy Comparator Normobaric oxygen therapy Outcomes Clinical benefits (e.g., faster metabolism of carbon monoxide) Clinical harms Guidelines Study Designs Health technology assessment reports, systematic reviews, meta-analyses, randomized controlled trials, non-randomized studies, evidence-based guidelines

RESULTS

Rapid Response reports are organized so that the higher quality evidence is presented first. Therefore, health technology assessment reports, systematic reviews, and meta-analyses are presented first. These are followed by randomized controlled trials, non-randomized studies, and evidence-based guidelines.

Two systematic reviews, one randomized controlled trial and one non-randomized study were identified regarding the comparative clinical effectiveness of hyperbaric oxygen therapy versus normobaric oxygen therapy for the treatment of acute carbon monoxide poisoning in adults. No relevant health technology assessment reports were identified. In addition, no evidence based guidelines regarding the treatment of acute carbon monoxide poisoning in adults were identified.

Additional references of potential interest are provided in the appendix.

Health Technology Assessments No literature identified.

Systematic Reviews and Meta-analyses

1. Buckley NA, Juurlink DN, Isbister G, Bennett MH, Lavonas EJ. Hyperbaric oxygen for carbon monoxide poisoning. Cochrane Database Syst Rev. 2011 Apr 13;(4):CD002041. PubMed: PM21491385

2. Smollin C, Olson K. Carbon monoxide poisoning (acute). BMJ Clin Evid [Internet]. 2010 Oct 12 [cited 2015 Mar 19];2010. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3217756 PubMed: PM21418677

Randomized Controlled Trials

3. Annane D, Chadda K, Gajdos P, Jars-Guincestre MC, Chevret S, Raphael JC. Hyperbaric oxygen therapy for acute domestic carbon monoxide poisoning: two randomized controlled trials. Intensive Care Med. 2011 Mar;37(3):486-92. PubMed: PM21125215

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Non-Randomized Studies

4. Kusuba Y, Taki K, Ohta A. Questionnaire results of hyperbaric oxygen therapy for acute carbon monoxide poisoning in Japan. Undersea Hyperb Med. 2012 Mar-Apr;39(2):639-45. PubMed: PM22530447

Guidelines and Recommendations No literature identified.

PREPARED BY: Canadian Agency for Drugs and Technologies in Health Tel: 1-866-898-8439 www.cadth.ca

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APPENDIX – FURTHER INFORMATION:

Systematic Reviews and Meta-analyses – Quality of Evidence

5. Murad MH, Altayar O, Bennett M, Wei JC, Claus PL, Asi N, et al. Using GRADE for evaluating the quality of evidence in hyperbaric oxygen therapy clarifies evidence limitations. J Clin Epidemiol. 2014 Jan;67(1):65-72. PubMed: PM24189086

Non-Randomized Studies

No Comparator

6. Kudo K, Otsuka K, Yagi J, Sanjo K, Koizumi N, Koeda A, et al. Predictors for delayed encephalopathy following acute carbon monoxide poisoning. BMC Emerg Med [Internet]. 2014 Jan 31 [cited 2015 Mar 19];14:3. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3909505 PubMed: PM24484081

Alternate Outcome

7. Dogan N, Savrun A, Levent S, Gunaydin G, Celik G, Akkucuk H, et al. Can initial lactate levels predict the severity of unintentional carbon monoxide poisoning? Hum Exp Toxicol. 2015 Mar;34(3):324-9. PubMed: PM24972621

8. Erenler AK, Yardan T, Baydin A, Gunay M, Amanvermez R. Heart-type fatty acid-binding protein as a potential biomarker of acute carbon monoxide poisoning. Am J Emerg Med. 2013 Aug;31(8):1165-9. PubMed: PM23809096

9. Garrabou G, Inoriza JM, Moren C, Oliu G, Miro O, Marti MJ, et al. Mitochondrial injury in human acute carbon monoxide poisoning: the effect of oxygen treatment. J Environ Sci Health C Environ Carcinog Ecotoxicol Rev. 2011;29(1):32-51. PubMed: PM21424975

Guidelines and Recommendations – Unclear Methodology

Hyperbaric Oxygen Therapy for Carbon Monoxide Poisoning

10. Hyperbaric oxygen therapy [Internet]. Birmingham (AL): BlueCross BlueShield of Alabama; 2014 Aug [cited 2015 Mar 19]. Available from: https://www.bcbsal.org/providers/policies/final/060.pdf See: Carbon monoxide poisoning, pages 3 and 11

11. Clinical commissioning policy: the use of hyperbaric oxygen therapy [Internet]. Leeds (GB): NHS Commissioning Board; 2013 Apr [cited 2015 Mar 19]. Available from: http://www.england.nhs.uk/wp-content/uploads/2013/04/d11-p-a.pdf See: Carbon monoxide poisoning, page 9 Summary of evidence of clinical and cost effectiveness of HBOT, page 10

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Appendix 2: Systematic review by NHS Quality Improvement Scotland, page 15

12. Oxygen therapy clinical best practice guideline [Internet]. Toronto: College of Respiratory Therapists of Ontario; 2013 Nov [cited 2015 Mar 19]. Available from: http://www.crto.on.ca/pdf/PPG/Oxygen_Therapy_CBPG.pdf See: Indications, page 37

13. Hyperbaric oxygen therapy: guidance to commissioners [Internet]. Birmingham (GB): University of Birmingham, West Midlands Commissioning Support Unit; 2012 Mar [cited 2015 Mar 19]. Available from: http://www.birmingham.ac.uk/Documents/college- mds/haps/projects/WMCSU/CommissioningPolicies/HBO.pdf See: Summary, page 4 B.2 Acute CO poisoning, page 6

14. Soar J, Perkins GD, Abbas G, Alfonzo A, Barelli A, Bierens JJ, et al. European Resuscitation Council Guidelines for Resuscitation 2010 Section 8. Cardiac arrest in special circumstances: Electrolyte abnormalities, poisoning, drowning, accidental hypothermia, hyperthermia, asthma, anaphylaxis, cardiac surgery, trauma, pregnancy, electrocution. Resuscitation [Internet]. 2010 Oct [cited 2015 Mar 19];81(10):1400-33. Available from: http://resuscitation-guidelines.articleinmotion.com/article/S0300-9572(10)00441-7/fulltext PubMed: PM20956045 See: Carbon monoxide, page 1406

15. Yan WW. The Hong Kong Society of Critical Care Medicine position statement: protocol of hyperbaric oxygen therapy for critically ill patients in Hong Kong [Internet]. Hong Kong: Hong Kong Society of Critical Care Medicine; 2010 May 18 [cited 2015 Mar 19]. Available from: http://www.hksccm.org/images/stories/PositionStatement/protocol_of_hyperbaric_oxygen_ therapy_in_hong_kong.pdf See: Table 1. Approved indications for HBO by the Undersea and Hyperbaric Medical Society, page 2

Review Articles

16. Chiew AL, Buckley NA. Carbon monoxide poisoning in the 21st century. Critical Care [Internet]. 2014 [cited 2015 Mar 20];18(2):221. Available from: http://ccforum.com/content/pdf/cc13846.pdf See: Hyperbaric oxygen, pages 5 to 6

17. Garg J, Krishnamoorthy P, Palaniswamy C, Khera S, Ahmad H, Jain D, et al. Cardiovascular abnormalities in carbon monoxide poisoning. Am J Ther. 2014 Feb 10. PubMed: PM24518173

18. Weaver LK. Hyperbaric oxygen therapy for carbon monoxide poisoning. Undersea Hyperb Med. 2014 Jul-Aug;41(4):339-54. PubMed: PM25109087

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19. Shah J. Hyperbaric oxygen therapy. J Am Col Certif Wound Spec [Internet]. 2010 Apr 24 [cited 2015 Mar 19];2(1):9-13. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3601859 PubMed: PM24527137

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