Carbon Monoxide Poisoning in Young Healthy Patient: Case Study of Heart Failure Recovery after Hyperbaric Oxygenation Treatment

Twenty years old patient, otherwise healthy was exposed to CO intoxication, presented to ER unconscious. Complete blood tests revealed significant CO intoxication and cardiac injury (COHb=41%, Tn=0.38 ng/dl, ST depression on inferior and anterior wall [II,III,AVF, V2­V5]). He was referred while being mechanically ventilated for Hyperbaric Oxygenation Treatment (HBOT) at another hospital. On arrival to HBO clinic prior to the hyperbaric treatment his COHb was normalized to 4.1%. Patient recieved 3 HBOTs of 2.4 ATA, 100% O , 120 min. duration each. Afterwards successful extubation performed, however echocardiography revealed estimated EF 30%, moderate­severe LV dysfunction and global hypokinesis. Three days later echocardiography showed remarkable improvement with normal LV size and global function. Next day patient discharged without complaints or permanent medications.

HBO treatment in cases of severe CO intoxication may improve cardiac outcomes of the patient especially if cardiac injury is suspected. It is advisable to consider referral of such patients to HBOT swiftly in order to minimize damage and improve recovery.

Moreover the significant heart dysfunction occurred when COHb levels was returned to normal. This emphasizes the fact that tissue injury occurred without correlation to oxygen supply normalization. Therefore myocardial stunning might occur without relation to COHb levels. Caregivers must keep in mind that other poisonous gases (e.g: cyanide) frequently present on burn sites, but are undetectable in patients` blood. Therefore meticulous assessment of patients at risk for cardiac stunning development by ECG and cardiac blood enzymes (e.g. Troponin) needed. Such patients should receive HBOT, if available, since they could benefit from such treatment and markedly improve their outcomes.