Written by Millie Cossé
Spoon Feed
Hyperbaric oxygen (HBO2) therapy may lead to slightly improved delayed neurologic outcomes – particularly improved memory – when compared to non-HBO2 in patients with acute carbon monoxide (CO) poisoning.
Lower the pressure
This ACEP policy expands on a 2017 ACEP policy that addressed key questions in the treatment of CO poisoning. The policy writers found new relevant studies that added to our understanding of the potential for hyperbaric oxygen (HBO2) therapy to affect long-term neurocognitive outcomes. The committee came to a similar conclusion as in 2017, that HBO2 therapy may provide some benefit in delayed cognitive outcomes, particularly memory impairment.
Of note, only one of four studies included in this policy update contained new patient data. The remaining three studies were meta-analyses that included the RCTs that were considered in making the 2017 ACEP policy for CO poisoning.
How will this change my practice?
It won’t. I don’t practice in a setting with access to HBO2, and based on current evidence, I think the risks of a prolonged transport on an ambulance with finite oxygen supply outweigh the minimal potential benefit of HBO2 for most patients with CO poisoning.
Source
A Critical Issue in the Management of Adult Patients Presenting to the Emergency Department With Acute Carbon Monoxide Poisoning: Approved by the ACEP Board of Directors January 22, 2025. Ann Emerg Med. 2025 Apr;85(4):e45-e59. doi: 10.1016/j.annemergmed.2024.12.005. PMID: 40118649
