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Non-invasive transcutaneous blood carboxyhaemoglobine level: reliability in victims of carbon monoxide poisoning
Title of the conference
79e Assemblée annuelle de la Société Suisse de Médecine Interne Générale
Lausanne, Suisse, 11-13 mai 2011
Swiss Medical Forum
Introduction: Carbon monoxide (CO) poisoning is one of the mostcommon causes of fatal poisoning. Symptoms of CO poisoning arenonspecific and the documentation of elevated carboxyhemoglobin(HbCO) levels in arterial blood sample is the only standard ofconfirming suspected exposure. The treatment of CO poisoning requiresnormobaric or hyperbaric oxygen therapy, according to the symptomsand HbCO levels. A new device, the Rad-57 pulse CO-oximeter allowsnoninvasive transcutaneous measurement of blood carboxyhemoglobinlevel (SpCO) by measurement of light wavelength absorptions.Methods: Prospective cohort study with a sample of patients, admittedbetween October 2008 - March 2009 and October 2009 - March 2010,in the emergency services (ES) of a Swiss regional hospital and aSwiss university hospital (Burn Center). In case of suspected COpoisoning, three successive noninvasive measurements wereperformed, simultaneously with one arterial blood HbCO test. A controlgroup includes patients admitted in the ES for other complaints (cardiacinsufficiency, respiratory distress, acute renal failure), but necessitatingarterial blood testing. Informed consent was obtained from all patients.The primary endpoint was to assess the agreement of themeasurements made by the Rad-57 (SpCO) and the blood levels(HbCO).Results: 50 patients were enrolled, among whom 32 were admitted forsuspected CO poisoning. Baseline demographic and clinicalcharacteristics of patients are presented in table 1. The median age was37.7 ans ± 11.8, 56% being male. Median laboratory carboxyhemoglobinlevels (HbCO) were 4.25% (95% IC 0.6-28.5) for intoxicated patientsand 1.8% (95 % IC 1.0-5.3) for control patients. Only five patientspresented with HbCO levels >= 15 %. The results disclose relatively faircorrelations between the SpCO levels obtained by the Rad-57 and thestandard HbCO, without any false negative results. However, theRad-57 tend to under-estimate the value of SpCO for patientsintoxicated HbCO levels >10% (fig. 1).Conclusions: Noninvasive transcutaneous measurement of bloodcarboxyhemoglobin level is easy to use.The correlation seems to be correct for low to moderate levels (<15%).For higher values, we observe a trend of the Rad-57 to under-estimatethe HbCO levels. Apart from this potential limitation and a few cases offalse-negative results described in the literature, the Rad-57 may beuseful for initial triage and diagnosis of CO poisoning.
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