Utility and outcomes of hydroxocobalamin use in smoke inhalation patients

•First study comparing treatment with hydroxocobalamin to a control efficacy group in smoke inhalation patients.•Treatment with hydroxocobalamin had no increased risk in mortality.•Its use is associated with lower pneumonia rates and ICU length of stay, and less ventilator days.

IntroductionHydroxocobalamin has been available for use for suspected cyanide toxicity in smoke inhalation patients in the United States since 2006. Our study compares outcomes of patients who received hydroxocobalamin to historical controls who did not.MethodsIn this retrospective review, patients administered hydroxocobalamin (2008-2014) were compared to historical controls (2002-2008). Patients <18 years, patients who received an alternate antidote, and patients without suspicion of smoke inhalation injury were excluded. Mortality was the primary outcome. Secondary outcomes evaluated were 7-day change in creatinine, culture-proven pneumonia, days on mechanical ventilation, ventilator- free days (VFD), ICU length of stay (ICU LOS), and hospital length of stay (HLOS).ResultsA total of 138 patients in the hydroxocobalamin group and 135 in the control group were identified. Mortality rate was similar between both groups (29% vs. 28%, p = 0.90). Hydroxocobalamin was associated with lower pneumonia rate (23% vs. 49%, p < 0.01), less ventilator days (4 days vs. 7 days, p < 0.01), and increased VFD (20 days vs. 11 days, p = 0.01) compared to controls. Shorter ICU LOS (6 days vs. 10 days, p = 0.03) and a trend toward lower HLOS (7 day vs. 11 days, p = 0.06) were also found in patients who received hydroxocobalamin.ConclusionsRoutine administration was associated with lower rate of pneumonia, faster liberation from the ventilator, and reductions in intensive care unit stay. Burn centers should consider its empiric use in suspected smoke inhalation patients.