Hyperbaric oxygen therapy (HBOT) is indicated for the emergency treatment of carbon monoxide poisoning complicated by cyanide
poisoning after smoke inhalation. Hyperbaric oxygen is also an adjunctive therapy for pure cyanide poisoning in patients who
do not respond to cyanide antidotes. HBOT dissolves additional oxygen in the blood plasma and has been shown to work effectively
alone and in combination with hydroxocobalamin (Cyanokit) and other cyanide antidote kits.
page in the Undersea and Hyperbaric Medical Society resource library to learn more about cyanide poisoning, the rationale
for hyperbaric oxygen therapy, and key clinical evidence, outcomes, and success factors.
The emergency treatment of smoke inhalation offers perhaps the single best reason for the healthcare community to demand
24/7 access to hyperbaric chambers across the US. Cyanide, carbon monoxide, inhaled particulates, and thermal injuries
together require speedy action to save the lives of firefighters and other fire victims. The clinical evidence for hyperbaric
oxygen may not be as strong for nonfire cyanide poisoning as for nonfire carbon monoxide poisoning, but the benefits of oxygen
are well established. As Medscape puts it:
Oxygen and sodium thiosulfate are the most widely accepted cyanide antidotes… The mechanism of action of oxygen
as a cyanide antidote is unclear, but it potentiates the effect of other antidotes. When used in the setting of smoke
inhalation, it is also therapeutic for CO poisoning. Thus, high concentrations of oxygen should be promptly delivered.
Smoke Inhalation Injury, Medscape, 22 Aug 2014
Ongoing surveillance projects and prospective trials may bolster the clinical case for hyperbaric oxygen therapy in the
routine treatment of smoke inhalation.