Purvis M V, Rooks H, Young Lee J, Longerich S, Kahn S A
Department of Surgery, The University of South Alabama Medical Center, Mobile, USA.
Department of Surgery, The University of Tennessee Health Science Center, Chattanooga, USA.
Ann Burns Fire Disasters. 2017 Jun 30;30(2):126-128.
Prehospital use of hydroxocobalamin as an antidote for cyanide toxicity, a serious complication of smoke inhalation, has yet to be universally adopted in the United States though its efficacy and safety have been demonstrated since 2006. The purpose of this study was to characterize practices of prehospital hydroxocobalamin administration via a survey of emergency medical services (EMS) and to report a case series from an EMS database to track use of hydroxocobalamin. The Fire Smoke Coalition Newsletter emailed a voluntary survey to EMS subscribers regarding hydroxocobalamin use. Survey responses were analyzed in addition to survival data from the Smoke Inhalation Treatment Database (SITD), a publically available, self-reported, online database for EMS regarding smoke inhalation patient outcomes. Analysis was compared to current published data from PubMed. The survey had a 14% response rate (284/2000). Only 38% reported prehospital utilization of a hydrogen cyanide antidote with 46% using hydroxocobalamin. 20% of responders reported a formal ALS protocol was in place for hydroxocobalamin use. For the SITD, 12 of 13 (92%) patients who received hydroxocobalamin for suspected inhalation survived. Other studies found a survival rate of 72% and 42% after administration of hydroxocobalamin for smoke inhalation. Prehospital administration of hydroxocobalamin for cyanide toxicity is uncommon in the United States, as evidenced by this analysis, despite well-documented safety and efficacy. Although a small sample, patients who received prehospital hydroxocobalamin had improved survival. This survival rate is significantly greater than those reported previously.
尽管自2006年以来已证明羟钴胺作为氰化物中毒解毒剂的有效性和安全性，但在美国，作为烟雾吸入严重并发症的氰化物中毒解毒剂，院前使用羟钴胺尚未得到普遍采用。本研究的目的是通过对紧急医疗服务（EMS）进行调查来描述院前羟钴胺给药的情况，并从EMS数据库报告一个病例系列以追踪羟钴胺的使用情况。火灾烟雾联盟通讯向EMS订阅者发送了一份关于羟钴胺使用情况的自愿调查问卷。除了烟雾吸入治疗数据库（SITD）的生存数据外，还对调查问卷的回复进行了分析。SITD是一个公开的、自我报告的在线数据库，用于记录EMS关于烟雾吸入患者的治疗结果。分析结果与来自PubMed的当前已发表数据进行了比较。该调查的回复率为14%（284/2000）。只有38%的人报告在院前使用了氰化氢解毒剂，其中46%使用了羟钴胺。20%的受访者报告有正式的高级生命支持（ALS）方案用于羟钴胺的使用。对于SITD，13名因疑似吸入而接受羟钴胺治疗的患者中有12名（92%）存活。其他研究发现，烟雾吸入患者使用羟钴胺后的生存率分别为72%和42%。尽管有充分记录的安全性和有效性，但通过本分析证明，在美国，院前使用羟钴胺治疗氰化物中毒并不常见。尽管样本量较小，但接受院前羟钴胺治疗的患者生存率有所提高。这一生存率明显高于先前报告的生存率。
