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Use of Cyanide Antidotes in Burn Patients With Suspected Inhalation Injuries in North America: A Cross-Sectional Survey

Dumestre, Danielle MD*; Nickerson, Duncan MD, FRCSC

doi: 10.1097/BCR.0b013e31829b3868
Original Articles

This study aimed to assess the use of cyanide antidotes and the determine the opinion on empiric administration of hydroxocobalamin in North American burn patients with suspected smoke inhalation injuries. An online cross-sectional survey was sent to directors of 90 major burn centers in North America, which were listed on the American Burn Association Web site. A multiple-choice format was used to determine the percentage of patients tested for cyanide poisoning on admission, the current administration of a cyanide antidote based solely on clinical suspicion of poisoning, and the antidote used. To ascertain views on immediate administration of hydroxocobalamin before confirmation of cyanide poisoning an option was included to expand the response in written format. Twenty-nine of 90 burn directors (32%) completed the survey. For the population of interest, the majority of burn centers (59%) do not test for cyanide poisoning on admission and do not administer an antidote based solely on clinical suspicion of cyanide poisoning (58%). The most commonly available antidote is hydroxocobalamin (50%), followed by the cyanide antidote kit (29%). The opinion regarding instant administration of hydroxocobalamin when inhalation injury is suspected is mixed: 31% support its empiric use, 17% do not, and the remaining 52% have varying degrees of confidence in its utility. In North America, most patients burnt in closed-space fires with inhalation injuries are neither tested for cyanide poisoning in a timely manner nor empirically treated with a cyanide antidote. Although studies have shown the safety and efficacy of empiric and immediate administration of hydroxocobalamin, most centers are not willing to do so.

From the *Department of Surgery, Section of Plastic Surgery, and Faculty of Medicine, University of Calgary, Alberta.

Address correspondence to Danielle Nickerson, MD, Department of Surgery, Section of Plastic Surgery, Foothills Medical Centre, University of Calgary, Room 385, 1403 29th Street NW, Calgary, Alberta T2N 2T9.

© 2014 The American Burn Association