This is the current release of the guideline.

Definitions for the strength of evidence (Class I-III) and strength of recommendations (Level A-C) are repeated at the end of the Major Recommendations.

Should hyperbaric oxygen (HBO₂) therapy be used for the treatment of patients with acute carbon monoxide (CO) poisoning?

Can clinical or laboratory criteria identify CO-poisoned patients who are most or least likely to benefit from this therapy?

Level A recommendations. None specified.

Level B recommendations. None specified.

Level C recommendations.

1. HBO₂ is a therapeutic option for CO-poisoned patients; however, its use cannot be mandated.
2. No clinical variables, including carboxyhemoglobin levels, identify a subgroup of CO-poisoned patients for whom HBO₂ is most likely to provide benefit or cause harm.

Definitions:

Strength of Evidence

Literature Classification Schema^

^ Some designs (e.g., surveys) will not fit this schema and should be assessed individually.

*Objective is to measure therapeutic efficacy comparing >2 interventions.

**Objective is to determine the sensitivity and specificity of diagnostic tests.

*** Objective is to predict outcome including mortality and morbidity.

Approach to Downgrading Strength of Evidence*

*See "Description of Methods Used to Analyze the Evidence" field for more information.

Strength of Recommendations

Level A recommendations. Generally accepted principles for patient management that reflect a high degree of clinical certainty (i.e., based on strength of evidence Class I or overwhelming evidence from strength of evidence Class II studies that directly address all of the issues)

Level B recommendations. Recommendations for patient management that may identify a particular strategy or range of management strategies that reflect moderate clinical certainty (i.e., based on strength of evidence Class II studies that directly address the issue, decision analysis that directly addresses the issue, or strong consensus of strength of evidence Class III studies)

Level C recommendations. Other strategies for patient management that are based on preliminary, inconclusive, or conflicting evidence, or, in the absence of any published literature, based on panel consensus

There are certain circumstances in which the recommendations stemming from a body of evidence should not be rated as highly as the individual studies on which they are based. Factors such as heterogeneity of results, uncertainty about effect magnitude and consequences, strength of prior beliefs, and publication bias, among others, might lead to such a downgrading of recommendations.

None provided

The type of supporting evidence is identified and graded for each recommendation (see "Major Recommendations" field).

Not applicable: The guideline was not adapted from another source.

2008 Feb

American College of Emergency Physicians - Medical Specialty Society

American College of Emergency Physicians

Clinical Policies Subcommittee (Writing Committee)

Clinical Policies Subcommittee (Writing Committee): Stephen J. Wolf, MD (Chair); Eric J. Lavonas, MD; Edward P. Sloan, MD, MPH; Andy S. Jagoda, MD

American College of Emergency Physicians Clinical Policies Committee (Oversight Committee): Andy S. Jagoda, MD, (Chair 2003-2006, Co-Chair 2006-2007); Wyatt W. Decker, MD (Co-Chair 2006-2007); Deborah B. Diercks, MD; Jonathan A. Edlow, MD; Francis M. Fesmire, MD; Steven A. Godwin, MD; Sigrid A. Hahn, MD; John M. Howell, MD; J. Stephen Huff, MD; Thomas W. Lukens, MD, PhD; Donna L. Mason, RN, MS, CEN (ENA Representative 2004-2006); Michael Moon, RN, CNS, MSN, CEN (ENA Representative 2004); Anthony M. Napoli, MD (EMRA Representative 2004-2006); Devorah Nazarian, MD; Jim Richmann, RN, BS, MA(c), CEN (ENA Representative 2006-2007); Scott M. Silvers, MD; Edward P. Sloan, MD, MPH; Molly E. W. Thiessen (EMRA Representative 2006-2007); Robert L. Wears, MD, MS (Methodologist); Stephen J. Wolf, MD; Cherri D. Hobgood, MD (Board Liaison 2004-2006); David C. Seaberg, MD, CPE (Board Liaison 2006-2007); Rhonda R. Whitson, RHIA, Staff Liaison, Clinical Policies Committee and Subcommittees

Relevant industry relationships for the following carbon monoxide poisoning subcommittee members are as follows: Dr. Lavonas was the Medical Director of Hyperbaric Medicine at Carolinas Medical Center, Charlotte, NC during the development of this clinical policy.

Relevant industry relationships are those relationships with companies associated with products or services that significantly impact the specific aspect of disease addressed in the critical question.

Emergency Nurses Association - Medical Specialty Society

This is the current release of the guideline.

None available

None available

This NGC summary was completed by ECRI Institute on April 16, 2008. The information was verified by the guideline developer on May 16, 2008.