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Summary of treatment strategies for acute carbon monoxide poisoning

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Treatment strategies fall into three categories: gas exchange, carbon monoxide scavenging, and pharmacological mitigation. Normobaric oxygen therapy, hyperbaric oxygen therapy, and isocapnic hyperpnea therapy rely on gas exchange in the lungs with accelerated carbon monoxide clearance driven by increased oxygen partial pressure or ventilation. In addition, extracorporeal membrane oxygenation facilitates carbon monoxide clearance via gas exchange in cases of extreme illness or lung damage, and extracorporeal removal of carbon monoxide with phototherapy facilitates this clearance through carbon monoxide photolysis. Carbon monoxide-scavenging therapeutics, including hemoprotein-based scavengers and small molecule-based scavengers, may directly sequester carbon monoxide from circulating hemoglobin (Hb) or cellular hemoproteins. These scavengers undergo rapid renal clearance to safely eliminate both scavenger molecules and carbon monoxide. Finally, pharmacological compounds are being explored to mitigate pathophysiological damage incurred during acute carbon monoxide poisoning (eg, steroids, anti-inflammatory drugs, and mitochondrial electron transport chain substrates). Abbreviations: ECCOR-P, extracorporeal removal of carbon monoxide with phototherapy; ECMO, extracorporeal membrane oxygenation; HBOT, hyperbaric oxygen therapy; IH, isocapnic hyperpnea; NBOT, normobaric oxygen therapy. (Source: Dent MR, Rose JJ, Tejero J, Gladwin MT. Carbon monoxide poisoning: from microbes to therapeutics. Annu Rev Med 2024;75:337-51. Creative Commons Attribution 4.0 International [CC BY 4.0] license, creativecommons.org/licenses/by/4.0.)