Behandlung von Kohlenmonoxidvergiftungen in Deutschland

Zusammenfassung

Hintergrund

Die Symptome einer akuten Kohlenmonoxid(CO-)Vergiftung sind unspezifisch und reichen von Kopfschmerzen bis zu Bewusstlosigkeit und Tod. Neben den Akutsymptomen können schwere neurologische Spätschäden auftreten. Die Zahl der in Deutschland amtlich registrierten Todesfälle aufgrund von CO-Vergiftung steigt an. Es liegen keine umfassenden Daten zur klinischen Symptomatik, zum Verlauf sowie zur Versorgungsqualität vor.

Methode

Als Grundlage dienen die Behandlungsdaten aller zwischen 2013 und 2017 im überregionalen Druckkammerzentrum (DKZ) Wiesbaden behandelten Patienten mit CO-Vergiftung. Ziele waren die vergleichende Darstellung von demografischen Daten, Vergiftungsquellen, initialen Symptomen, Behandlungsverläufen sowie die Auswertung von zeitlichen Abläufen der präklinischen und stationären Versorgung.

Ergebnis

Zwischen 2013 und 2017 wurden 476 Patienten mit einem durchschnittlichen CO-Hb-Anteil von 15 % (Q_0,25 = 7,6 %; Q_0,75 = 22,3 %) in der Blutgasanalyse (BGA) erfasst. Die häufigsten Symptome umfassten Kopfschmerzen, Schwindel, Übelkeit und Synkopen. Insgesamt vergingen vom medizinischen Erstkontakt bis zum BGA-Nachweis 91 min (Q_0,25 = 53 min; Q_0,75 = 147 min). Insgesamt verstarben 6 Patienten, 430 Patienten zeigten sich im Verlauf symptomfrei, 40 Patienten berichteten auch nach Abschluss der Behandlung über Symptome.

Schlussfolgerung

Die Analyse zeigt eine lange Zeitspanne zwischen Diagnosestellung und Behandlungsbeginn. Neben CO-Quellen wie Brand, Verbrennungsöfen und Holzkohlegrills zeigte sich eine hohe Anzahl von Intoxikationen nach Wasserpfeifenkonsum. Diese Studie unterstreicht die Notwendigkeit, bei Vorliegen unspezifischer neurologischer Symptome insbesondere bei jungen Patienten die Differenzialdiagnose CO-Vergiftung zu berücksichtigen und bei begründetem Verdacht unverzüglich zu behandeln.

Abstract

Background

The symptoms of acute carbon monoxide (CO) poisoning are unspecific, ranging from headaches to unconsciousness and death. In addition to acute symptoms, delayed severe neurological sequelae may occur. While a total of 440 deaths by CO poisoning were registered in Germany in 1999, a total of 594 patients died (0.73 per 100,000 inhabitants) in 2014 and in 2015 the number even increased to 648 deaths. A national database on clinical symptoms, course of illness or quality of care concerning CO poisoning does not yet exist.

Methods

The treatment data of patients admitted to the Hyperbaric Emergency Centre Wiesbaden (HEC) from 2013 to 2017 with CO poisoning formed the basis of the study. This was a comparative evaluation of patient demographics, poisoning sources, symptom spectrum, course of treatment and time intervals registered on the preclinical and clinical levels.

Results

From 2013 to 2017 a total of 476 patients (282 men and 194 women) with an average non-invasively measured CO-Hb of 15% (Q_0.25 = 7.6%, Q_0.75 = 22.3%) were treated with hyperbaric oxygen. Heaters (n = 131), charcoal barbecues (n = 93), fires (n = 90), hookahs (n = 78) and combustion engines (n = 37) were the most frequent CO sources identified. Headaches, vertigo, nausea and syncope were the most prevalent symptoms. A median of 91 min (Q_0.25 = 53 min; Q_0.75 = 147 min) passed between first medical contact and BGA-validated diagnosis. In total, 151 patients were transferred directly to the HEC, whereas 325 patients were secondarily transferred. The delay in this subgroup took 183 min (median Q_0.25 = 138 min; Q_0.75 = 248 min). After receiving the first hyperbaric treatment, 80% were free of symptoms. Remaining symptoms included headache (10%), fatigue (8%), vertigo (5%) and nausea (3%) and 45 patients terminated further treatment. Of the patients 417 received a second hyperbaric treatment and 370 patients were treated 3 times. After the third treatment, 89% were free of symptoms and 5% still reported headaches, 3% vertigo and 2% fatigue. In total, 6 patients died and 430 patients were symptom-free after treatment.

Conclusion

Commonly known sources (fire, charcoal grills) aside, many poisonings by smoking a hookah were observed. This study highlights the importance of considering CO poisoning as a differential diagnosis when encountering patients, especially of younger age, with non-specific neurological symptoms, as well as the importance of early initiation of treatment. A direct correlation between CO-Hb values (whether measured noninvasively or by invasive BGA) and the initial symptoms could not be demonstrated. In total, substantial time expired between the diagnosis and start of treatment of patients transported to a primary care hospital compared to those transported directly to the HEC. Although analysis showed adequate treatment with oxygen in the preclinical interval, administration of oxygen during primary hospital stay showed room for improvement. Introducing a national CO poisoning register and uniform treatment guidelines could improve in-house clinical processes. Multicenter studies are needed to close the gaps identified in the quality of care in Germany.