Division of Clinical Toxicology, Department of Emergency Medicine, VCU Medical Center, Richmond, VA, United States of America; Virginia Poison Center, Richmond, VA, United States of America; Department of Emergency Medicine, VCU Medical Center, Richmond, VA, United States of America.
Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, United States of America.
Am J Emerg Med. 2021 Dec;50:365-368. doi: 10.1016/j.ajem.2021.08.056. Epub 2021 Aug 25.
The indications for prehospital hydroxocobalamin are not well defined. The aim of this study was to evaluate prehospital signs and symptoms in patients who received hydroxocobalamin to improve future use.
In this retrospective study, all patients who received prehospital Hydroxocobalamin at a tertiary care burn center from December 2012 to March 2018 were reviewed. Each case was evaluated for evidence of suspected cyanide toxicity: hypotension, syncope, CNS depression/altered mentation, seizures, respiratory or cardiac arrest. A determination was made whether or not hydroxocobalamin was indicated.
In this study, EMS providers administered hydroxocobalamin to 42 patients between December 2012 and March 2018. The majority (71%) of suspected cyanide exposures were from house fires. The most common prehospital findings were coma or depressed CNS (36%), followed by hypotension (16%) and cardiac arrest (12%). Sixty percent of patients treated with hydroxocobalamin had none of the six clinical indicators for potential cyanide toxicity. Carboxyhemoglobin and serum lactate were significantly different in patients that had a clinical indication for hydroxocobalamin compared to those who did not.
Prehospital hydroxocobalamin was used empirically however, indications are unclear. Using defined clinical indications may provide greater clarity for providers and reduce unnecessary use of hydroxocobalamin.
氢钴胺的院前适应证尚未明确。本研究旨在评估接受氢钴胺治疗的患者的院前症状和体征，以改善未来的应用。
在这项回顾性研究中，回顾了 2012 年 12 月至 2018 年 3 月期间在一家三级烧伤中心接受院前氢钴胺治疗的所有患者。每个病例均评估是否存在疑似氰化物毒性的证据：低血压、晕厥、CNS 抑制/意识改变、癫痫发作、呼吸或心脏骤停。判断是否需要使用氢钴胺。
在这项研究中，EMS 提供者在 2012 年 12 月至 2018 年 3 月期间向 42 名患者使用了氢钴胺。大多数（71%）疑似氰化物暴露来自家庭火灾。最常见的院前发现是昏迷或中枢神经系统抑制（36%），其次是低血压（16%）和心脏骤停（12%）。接受氢钴胺治疗的 60%的患者没有出现六种潜在氰化物毒性的临床指标。与未使用氢钴胺的患者相比，接受氢钴胺治疗的患者的碳氧血红蛋白和血清乳酸明显不同。
虽然氢钴胺是在经验性基础上用于院前治疗，但适应证尚不清楚。使用明确的临床适应证可能为提供者提供更大的清晰度，并减少氢钴胺的不必要使用。
