Comparison of the effects of hyperbaric and normobaric oxygen treatments on the repolarisation parameters of electrocardiography in children with carbon monoxide poisoning

Year 2021, , 1606 - 1613, 30.12.2021

Zafer Bağcı , Abdullah Arslan , Derya Arslan , Ayşenur Kolsuz

https://doi.org/10.17826/cumj.983115

Abstract

Purpose: The aim of this study was to compare the effects of hyperbaric oxygen therapy (HBOT) induced hyper-oxygenation and normobaric oxygen therapy (NBOT) on myocardial repolarisation parameters in children with carbon monoxide (CO) poisoning.
Materials and Methods: This prospective study included 77 girls and boys aged 0–18 years who were diagnosed and treated for CO poisoning. There were no changes in the routine clinical evaluation and treatment practices of patients. Patients who received NBOT (n=40) and HBOT (n=37) were divided into two groups. These groups were compared in terms of their demographic characteristics, carboxyhaemoglobin, lactate, troponin levels and myocardial repolarisation parameters of electrocardiography (ECG) (Tp-e interval, Tp-e dispersion, QTc and Tp-e/QTc ratio).
Results: There were no significant intergroup differences in terms of carboxyhaemoglobin, lactate and troponin levels at the time of admission; admission and post-treatment Tp-e, Tp-e dispersion, corrected QTc and TPe/QTc ratio and post-treatment change rates of each ECG parameter.
Conclusion: There was no intergroup difference in terms of repolarisation parameters of ECG in children with CO poisoning. The possible reason for this may be myocardial reperfusion damage due to hyper-oxygenation associated with HBOT therapy.

Keywords

Carbon monoxide poisoning, electrocardiography, hyperbaric oxygen, child

Thanks

We thank the contributors to this study.

Karbonmonoksit zehirlenmesi olan çocuklarda hiperbarik ve normobarik oksijen tedavilerinin elektrokardiyografinin repolarizasyon parametreleri üzerindeki etkilerinin karşılaştırılması

Abstract

Amaç: Bu çalışmanın amacı, karbon monoksit (CO) zehirlenmesi olan çocuklarda hiperbarik oksijen tedavisi (HBOT) ile oluşturulan hiperoksijenasyonun ve normobarik oksijen tedavisinin (NBOT) miyokardiyal repolarizasyon parametreleri üzerindeki etkilerini karşılaştırmaktı.
Gereç ve Yöntem: Bu prospektif çalışmaya CO zehirlenmesi tanısı konulan ve tedavi edilen 0-18 yaş arası kız ve erkek çocuklar dahil edildi. Hastaların rutin klinik değerlendirme ve tedavi uygulamalarında değişiklik olmadı. Hastalar NBOT yapılanlar (n=40) ve HBOT yapılanlar (n=37) olarak iki gruba ayrıldı. Bu gruplar, demografik özellikler, karboksihemoglobin, laktat, troponin düzeyleri ve elektrokardiyografinin (EKG) miyokardiyal repolarizasyon parametreleri (Tp-e aralığı, Tp-e dispersiyonu, QTc ve Tp-e / QTc oranı) yönünden karşılaştırıldı.
Bulgular: Gruplar arasında başvurudaki COHb, laktat, troponin düzeyleri; başvuruda ve tedavi sonrası Tpe, Tpe dağılımı, düzeltilmiş QTc ve TPe/QTc oranları ve her bir EKG parametresinin tedavi sonrası değişim oranları yönünden anlamlı bir farklılık saptanmadı.
Sonuç: CO zehirlenmesi olan çocuklarda EKG repolarizasyon parametreleri açısından gruplar arasında fark yoktu. Bunun olası nedeni, HBOT tedavisi ile ilişkili hiperoksijenasyona bağlı miyokardiyal reperfüzyon hasarı olabilir.

Keywords

Karbonmonoksit zehirlenmesi, elektrokardiyografi, hiperbarik oksijen, çocuk

References

• 1. Raub JA, Mathieu-Nolf M, Hampson NB, Thom SR. Carbon monoxide poisoning-a public health perspective. Toxicology. 2000;145(1):1-14.
• 2. Blumenthal I. Carbon monoxide poisoning. J R Soc Med. 2001;94(6):270-2.
• 3. Aslan S, Uzkeser M, Seven B, Gundogdu F, Acemoglu H, Aksakal E et al. The evaluation of myocardial damage in 83 young adults with carbon monoxide poisoning in the East Anatolia region in Turkey. Hum Exp Toxicol. 2006;25(8):439-46.
• 4. Yelken B, Tanriverdi B, Cetinbas F, Memis D, Sut N. The assessment of QT intervals in acute carbon monoxide poisoning. Anatolian Journal of Cardiology. 2009;9(5):397-400.
• 5. Akilli NB, Akinci E, Akilli H, Dundar ZD, Koylu R, Polat M et al. A new marker for myocardial injury in carbon monoxide poisoning: T peak-T end. Am J Emerg Med. 2013;31(12):1651-5.
• 6. Eroglu M, Yildirim AO, Uz O, Isilak Z, Yalcin M, Kardesoglu E. Carbon monoxide poisoning increases Tpeak–Tend dispersion and QTc dispersion. Cardiovascular Journal of Africa. 2014;25(3):106.
• 7. Ozyurt A, Karpuz D, Yucel A, Tosun MD, Kibar AE, Hallioglu O. Effects of Acute Carbon Monoxide Poisoning on ECG and Echocardiographic Parameters in Children. Cardiovasc Toxicol. 2017;17(3):326-334.
• 8. Akyol S, Erdogan S, Idiz N, Celik S, Kaya M, Ucar F et al. The role of reactive oxygen species and oxidative stress in carbon monoxide toxicity: an in-depth analysis. Redox Rep. 2014;19(5):180-9.
• 9. Lippi G, Rastelli G, Meschi T, Borghi L, Cervellin G. Pathophysiology, clinics, diagnosis and treatment of heart involvement in carbon monoxide poisoning. Clinical biochemistry. 2012;45(16-17):1278-1285.
• 10. Mathieu D, Marroni A, Kot JJD, medicine h. Tenth European Consensus Conference on Hyperbaric Medicine: recommendations for accepted and non-accepted clinical indications and practice of hyperbaric oxygen treatment. 2017;47(1):24.
• 11. Besli GE, Erguven M, Karadogan M, Yılmaz Ö. Çocuklarda Karbon Monoksit Zehirlenmesi. Journal of Academic Emergency Medicine/Akademik Acil Tip Olgu Sunumlari Dergisi. 2010;9(1):26-30.
• 12. Qiu H, Bird GL, Qu L, Vetter VL, White PS. Evaluation of QT interval correction methods in normal pediatric resting ECGs. in 2007 Computers in Cardiology. Durham, NC, USA: IEEE.
• 13. Adir Y, Merdler A, Haim SB, Harduf R, Bitterman H. Effects of exposure to low concentrations of carbon monoxide on exercise performance and myocardial perfusion in young healthy men. Occupational and Environmental Medicine. 1999;56(8):535-538.
• 14. Douglas C, Haldane J, Haldane J. The laws of combination of haemoglobin with carbon monoxide and oxygen. The Journal of physiology. 1912;44(4):275-304.
• 15. Prockop LD, Chichkova RI. Carbon monoxide intoxication: an updated review. Journal of the neurological sciences. 2007;262(1-2):122-130.
• 16. Tritapepe L, Macchiarelli G, Rocco M, Scopinaro F, Schillaci O, Martuscelli E et al. Functional and ultrastructural evidence of myocardial stunning after acute carbon monoxide poisoning. 1998;26(4):797-801.
• 17. Satran D, Henry CR, Adkinson C, Nicholson CI, Bracha Y, Henry TD. Cardiovascular manifestations of moderate to severe carbon monoxide poisoning. J Am Coll Cardiol. 2005;45(9):1513-6.
• 18. Kalay N, Ozdogru I, Cetinkaya Y, Eryol NK, Dogan A, Gul I et al. Cardiovascular effects of carbon monoxide poisoning. Am J Cardiol. 2007;99(3):322-4.
• 19. Dragelyte G, Plenta J, Chmieliauskas S, Jasulaitis A, Raudys R, Jovaisa T et al. Myocardial Rupture following Carbon Monoxide Poisoning. Case Rep Crit Care. 2014;2014:281701.
• 20. Teksam O, Gumus P, Bayrakci B, Erdogan I, Kale G. Acute cardiac effects of carbon monoxide poisoning in children. Eur J Emerg Med. 2010;17(4):192-6.
• 21. Gandini C, Castoldi AF, Candura SM, Locatelli C, Butera R, Priori S et al. Carbon monoxide cardiotoxicity. Journal of Toxicology: Clinical Toxicology. 2001;39(1):35-44.
• 22. Carnevali R, Omboni E, Rossati M, Villa A, Checchini M. Electrocardiographic changes in acute carbon monoxide poisoning. Minerva medica. 1987;78(3):175-178.
• 23. Hajsadeghi S, Tavakkoli N, Kerman SRJ, Shahabadi A, Khojand M. Electrocardiographic findings and serum troponin I in carbon monoxide poisoned patients. Acta Medica Iranica. 2012;50(3):185-191.
• 24. Andre L, Boissiere J, Reboul C, Perrier R, Zalvidea S, Meyer G et al. Carbon monoxide pollution promotes cardiac remodeling and ventricular arrhythmia in healthy rats. Am J Respir Crit Care Med. 2010;181(6):587-95.
• 25. Gupta P, Patel C, Patel H, Narayanaswamy S, Malhotra B, Green JT et al. Tp-e/QT ratio as an index of arrhythmogenesis. Journal of electrocardiology. 2008;41(6):567-574.
• 26. Castro Hevia J, Antzelevitch C, Tornes Barzaga F, Dorantes Sanchez M, Dorticos Balea F, Zayas Molina R et al. Tpeak-Tend and Tpeak-Tend dispersion as risk factors for ventricular tachycardia/ventricular fibrillation in patients with the Brugada syndrome. J Am Coll Cardiol. 2006;47(9):1828-34.
• 27. Yan GX, Antzelevitch C. Cellular basis for the normal T wave and the electrocardiographic manifestations of the long-QT syndrome. Circulation. 1998;98(18):1928-36.
• 28. Panikkath R, Reinier K, Uy-Evanado A, Teodorescu C, Hattenhauer J, Mariani R et al. Prolonged Tpeak-to-tend interval on the resting ECG is associated with increased risk of sudden cardiac death. Circ Arrhythm Electrophysiol. 2011;4(4):441-7.
• 29. Kavakli HS, Erel O, Delice O, Gormez G, Isikoglu S, Tanriverdi F. Oxidative stress increases in carbon monoxide poisoning patients. Hum Exp Toxicol. 2011;30(2):160-4.
• 30. Sun Q, Cai J, Zhou J, Tao H, Zhang JH, Zhang W et al. Hydrogen-rich saline reduces delayed neurologic sequelae in experimental carbon monoxide toxicity. Crit Care Med. 2011;39(4):765-9.
• 31. Knauert M, Vangala S, Haslip M, Lee PJ. Therapeutic applications of carbon monoxide. Oxid Med Cell Longev. 2013;2013:360815.
• 32. Tintinalli JE, Kelen GD, Stapcyzynski SJ. Carbon monoxide poisoning. In Emergency Medicine: A Comprehensive Study Guide (Eds Tintinalli JE, Kelen GD, Stapcyzynski SJ):1302-1306. North Carolina: McGraw-Hill, 2000.