European Survey: Risk of Cyanide Poisoning in Smoke Inhalation (RISK)

European Survey: Risk of Cyanide Poisoning in Smoke Inhalation, Symptoms, Key Treatment and Outcome (RISK)

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

Study Overview

• Status: Completed
• Conditions: Smoke Inhalation Patients
• Intervention / Treatment: Other: There is no intervention planned (observational)

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.

• Study Type: Observational
• Enrollment (Actual): 102

Contacts and Locations

Study Locations

• Germany
  • Ludwigsburg, Germany, 71640
    • Prof. Dr. Götz Geldner
  • München, Germany, 81675
    • Prof. Th. Zilker

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Probability Sample

Study Population

Patients with smoke inhalation

Description

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

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
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

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Overall Survival After 24 Hours	Number of participants who survived at 24 hours after smoke inhalation were reported.	24 hours
Serum Cyanide Levels		blood sampling within 2 hours after smoke inhalation

Collaborators and Investigators

• Sponsor: Dr. Ernst MW Koch
• Investigators: 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

Publications and helpful links

General Publications

• Geldner G, Koch EM, Gottwald-Hostalek U, Baud F, Burillo G, Fauville JP, Levi F, Locatelli C, Zilker T. Report on a study of fires with smoke gas development : determination of blood cyanide levels, clinical signs and laboratory values in victims. Anaesthesist. 2013 Aug;62(8):609-16. doi: 10.1007/s00101-013-2209-3. Epub 2013 Aug 7.

Study record dates

Study Major Dates

• Study Start: April 1, 2009
• Primary Completion (Actual): June 1, 2012
• Study Completion (Actual): July 1, 2012

Study Registration Dates

• First Submitted: June 27, 2011
• First Submitted That Met QC Criteria: June 30, 2011
• First Posted (Estimate): July 1, 2011

Study Record Updates

• Last Update Posted (Estimate): September 28, 2016
• Last Update Submitted That Met QC Criteria: August 5, 2016
• Last Verified: August 1, 2016

More Information

Terms related to this study

• Keywords: Smoke, cyanide, closed space fires
• Additional Relevant MeSH Terms: Chemically-Induced Disorders; Pathologic Processes; Respiratory Tract Diseases; Respiration Disorders; Wounds and Injuries; Burns, Inhalation; Burns; Poisoning; Respiratory Aspiration; Smoke Inhalation Injury
• Other Study ID Numbers: EML015722-600; 2009-010202-11 (Other Identifier: EudraCT No)