• Jeff Kamta, Kaylee Maynard, Rachel F Schult, Derek E Bell, JonesCourtney M CCMCUniversity of Rochester Medical Center, Department of Emergency Medicine, 601 Elmwood Ave, Box 655, Rochester, NY 14642, USA., and Nicole M Acquisto.
• (Attribution) University of Rochester Medical Center, Department of Pharmacy, 601 Elmwood Ave, Box 638, Rochester, NY 14642, USA. Electronic address: jeffkamta@gmail.com.
• Burns. 2024 Feb 1; 50 (1): 157166157-166.

AbstractHydroxocobalamin is used for cyanide toxicity after smoke inhalation, but diagnosis is challenging. Retrospective studies have associated hydroxocobalamin with acute kidney injury (AKI). This is a retrospective analysis of patients receiving hydroxocobalamin for suspected cyanide toxicity. The primary outcome was the proportion of patients meeting predefined appropriate use criteria defined as ≥1 of the following: serum lactate ≥8 mmol/L, systolic blood pressure (SBP) <90 mmHg, new-onset seizure, cardiac arrest, or respiratory arrest. Secondary outcomes included incidence of AKI, pneumonia, resolution of initial neurologic symptoms, and in-hospital mortality. Forty-six patients were included; 35 (76%) met the primary outcome. All met appropriate use criteria due to respiratory arrest, 15 (43%) for lactate, 14 (40%) for SBP, 12 (34%) for cardiac arrest. AKI, pneumonia, and resolution of neurologic symptoms occurred in 30%, 21%, and 49% of patients, respectively. In-hospital mortality was higher in patients meeting criteria, 49% vs. 9% (95% CI 0.16, 0.64). When appropriate use criteria were modified to exclude respiratory arrest in a post-hoc analysis, differences were maintained, suggesting respiratory arrest alone is not a critical component to determine hydroxocobalamin administration. Predefined appropriate use criteria identify severely ill smoke inhalation victims and provides hydroxocobalamin treatment guidance.Copyright © 2023 Elsevier Ltd and ISBI. All rights reserved.

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