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European Survey: Risk of Cyanide Poisoning in Smoke Inhalation (RISK)
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Purpose
Cyanide poisoning is commonly viewed as a rare but dramatic event, occurring in industrial or laboratory settings as the result of accidental releases of hydrogen cyanide (HCN) gas (e.g. in the case of fire) or salts in the case of suicide attempts.
In fact, cyanide poisoning is considerably more common than is generally appreciated. Multiple clinical and post-mortal studies have demonstrated that HCN contributes to the toxicity of fire smoke.
Cyanide acts primarily through its strong affinity for the iron-containing heme moiety, binding to numerous critical enzyme systems in the body and rendering them inactive. Of late, increasing attention has been paid to the relationship of cyanide and nitric oxide. The interactions appear to be complex, with cyanide inducing nitric oxide production by binding to N-methyl-D-aspartate (NMDA) receptors, as well as binding to nitric oxide synthase. The latter may be overcome by the presence of nitric oxide synthase inhibitors.
Probably, the majority of the cyanide poisoning cases are due to smoke inhalation in closed-space fires.
So far, there are no clear data available on the prevalence of cyanide poisoning in smoke inhalation.
This information would be of great interest for all emergency physicians since a proven or supposed cyanide poisoning does not only requires an intensive supportive care, including the administration of supplemental oxygen and artificial ventilation, blood pressure support, and anticonvulsants, but also a rapid administration of a cyanide antidote.
Therefore, it is the goal of this survey to assess the prevalence of cyanide poisoning in smoke inhalation victims. Only the data of patients with a cyanide measurement before specific antidote treatment will be included
| Condition | Intervention |
|---|---|
| Smoke Inhalation Patients | Other: There is no intervention planned (observational) |
| Study Type: | Observational |
| Study Design: | Observational Model: Cohort Time Perspective: Prospective |
| Official Title: | European Survey: Risk of Cyanide Poisoning in Smoke Inhalation, Symptoms, Key Treatment and Outcome (RISK) |
- Overall Survival After 24 Hours [ Time Frame: 24 hours ]Number of participants who survived at 24 hours after smoke inhalation were reported.
- Serum Cyanide Levels [ Time Frame: blood sampling within 2 hours after smoke inhalation ]
| Enrollment: | 102 |
| Study Start Date: | April 2009 |
| Study Completion Date: | July 2012 |
| Primary Completion Date: | June 2012 (Final data collection date for primary outcome measure) |
| Groups/Cohorts | Assigned Interventions |
|---|---|
|
Smoke Inhalation patients
Closed space fire, Soot deposits, Altered mental status Blood specimen before intravenous antidote treatment (cyanide measurement) Known delay between end of smoke exposure and blood sampling
|
Other: There is no intervention planned (observational)
No intervention foreseen
|
Detailed Description:
Cyanide poisoning is commonly viewed as a rare but dramatic event, occurring in industrial or laboratory settings as the result of accidental releases of hydrogen cyanide (HCN) gas (e.g. in the case of fire) or salts in the case of suicide attempts.
In fact, cyanide poisoning is considerably more common than is generally appreciated. Multiple clinical [1-4] and post-mortal studies [5-10] have demonstrated that HCN contributes to the toxicity of fire smoke.
Cyanide acts primarily through its strong affinity for the iron-containing heme moiety, binding to numerous critical enzyme systems in the body and rendering them inactive [11]. Of late, increasing attention has been paid to the relationship of cyanide and nitric oxide. The interactions appear to be complex, with cyanide inducing nitric oxide production by binding to N-methyl-D-aspartate (NMDA) receptors [12], as well as binding to nitric oxide synthase. The latter may be overcome by the presence of nitric oxide synthase inhibitors.
Probably, the majority of the cyanide poisoning cases are due to smoke inhalation in closed-space fires.
So far, there are no clear data available on the prevalence of cyanide poisoning in smoke inhalation.
This information would be of great interest for all emergency physicians since a proven or supposed cyanide poisoning does not only requires an intensive supportive care, including the administration of supplemental oxygen and artificial ventilation, blood pressure support, and anticonvulsants, but also a rapid administration of a cyanide antidote.
Therefore, it is the goal of this survey to assess the prevalence of cyanide poisoning in smoke inhalation victims. Only the data of patients with a cyanide measurement before specific antidote treatment will be included.
Eligibility| Ages Eligible for Study: | Child, Adult, Senior |
| Sexes Eligible for Study: | All |
| Accepts Healthy Volunteers: | No |
| Sampling Method: | Probability Sample |
Inclusion Criteria:
- Closed space fire, Soot deposits, Altered mental status
- Blood specimen before intravenous antidote treatment (cyanide measurement)
- Known delay between end of smoke exposure and blood sampling
- Malaise and/or Headache and/or Altered mental status in fire workers
Exclusion Criteria:
- Pregnancy
- Multiple trauma, Blast
- Patient pronounced dead at scene without resuscitation attempt
- Patient in whom the time elapsed between the end of exposure and blood sampling is greater than 2 hours
Contacts and LocationsPlease refer to this study by its ClinicalTrials.gov identifier: NCT01386788
| Germany | |
| Prof. Dr. Götz Geldner | |
| Ludwigsburg, Germany, 71640 | |
| Prof. Th. Zilker | |
| München, Germany, 81675 | |
| Study Chair: | Thomas Zilker, Prof. | TU München |
| Study Chair: | Carlo A Locatelli, Prof | IRCCS Fondazione Maugeri |
| Study Chair: | Frédéric Baud, Prof | Hôpital Lariboisière |
| Study Chair: | Guillermo Burillo-Putze, Prof | Universidad de Teneriffe |
| Study Chair: | Jean-Philippe Fauville, Dr | To be added |
| Study Chair: | Francois Levy, Dr | To be added |
More Information
Publications:
| Responsible Party: | Dr. Ernst MW Koch, Dr |
| ClinicalTrials.gov Identifier: | NCT01386788 History of Changes |
| Other Study ID Numbers: |
EML015722-600 2009-010202-11 ( Other Identifier: EudraCT No ) |
| Study First Received: | June 27, 2011 |
| Results First Received: | September 13, 2013 |
| Last Updated: | August 5, 2016 |
Keywords provided by Dr. Ernst MW Koch:
|
Smoke, cyanide, closed space fires |
Additional relevant MeSH terms:
|
Respiratory Aspiration Poisoning Smoke Inhalation Injury Respiration Disorders Respiratory Tract Diseases |
Pathologic Processes Chemically-Induced Disorders Burns, Inhalation Burns Wounds and Injuries |
ClinicalTrials.gov processed this record on August 23, 2017