Acute cardiac effects of carbon monoxide poisoning in children

Ozlem Teksam, Pinar Gumus, Benan Bayrakci, Ilkay Erdogan, Gulsev Kale
European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine 2010, 17 (4): 192-6

OBJECTIVE: Carbon monoxide (CO)-induced cardiotoxicity has been investigated infrequently in children and reports of its cardiovascular effects are limited to isolated case reports. Our aims were to describe acute cardiac effects and associated factors with myocardial injury in children with CO poisoning.

METHODS: We reviewed the medical records of children below 17 years of age who were diagnosed with CO poisoning at pediatric emergency department between July 2004 and June 2007. Patients who had carboxyhemoglobin level at least 10% were included. Myocardial injury was defined as elevated cardiac biomarkers (creatine kinase-MB or troponin-t). Carboxyhemoglobin level, electrocardiogram (ECG) findings, cardiac biomarkers, and echocardiograph results were recorded for each patient.

RESULTS: Cardiac biomarkers were drawn in 107 patients, of which 16 patients (15%) had cardiac biomarkers confirmed diagnosis of myocardial injury. Sinus tachycardia was present in 32% of patients on baseline ECG. None of the patients had ischemic changes on ECG. Echocardiograph was performed in 27 patients (25% of patients with biomarkers drawn), of which nine patients had low ejection fraction and abnormal left ventricular function. Determinators of myocardial injury included a Glasgow Coma Scale (GCS) score <or=14 and hypotension (for GCS score <or=14 and hypotension, relative risk: 90 and 95% confidence interval: 9.9-813.

CONCLUSION: Myocardial injury may exist in children with CO poisoning without abnormal ECG findings. GCS score <or=14 and hypotension were associate factors with myocardial injury.

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