Non-Invasive Pulse CO-oximetry Screening in the Emergency Department Identifies Occult Carbon Monoxide Toxicity

Neurologic and Pregnancy Effects of Carbon Monoxide Exposure

“…A handheld pulse co-oximeter capable of determining SpCO much like a typical pulse oximeter does is available (Massimo Corporation, Irvine, CA, USA). There is some debate as to the absolute accuracy of this device, leading most facilities use this handheld oximeter as a screening tool -if an elevated COHb is found, then traditional carboxyhemoglobin determination by co-oximetry is ordered [33].…”

Health hazard evaluation report: HETA-2008-0245-3127, determining base camp personnel exposures to carbon monoxide during wildland fire suppression activities - California.

“…Unlike exhaled breath CO testing, this instrument allows noninvasive measurement of COHb without subject cooperation or effort. Pulse CO-oximetry has been shown to be a reliable method of measuring COHb [Mottram et al 2005;Barker et al 2006;Hampson et al 2006;Chee et al 2008;Suner et al 2008;Suner and McMurdy 2009].…”

Noninvasive Carbon Monoxide Detection: Insufficient Evidence for Broad Clinical Use

“…Several small studies have found a good correlation between the 2 values, although, notably, 2 of these studies involved only 9 and 10 healthy volunteers, 12,13 and other studies have only tested correlation among subjects with low COHb levels. 9,14 A retrospective review of 10,856 patients screened with the Rad-57 upon presentation to the ED found 11 cases of occult CO poisoning, 15 and a case series of 7 patients out of 74,880 patients screened 16 reported on the utility of using screening to detect occult poisonings. While these papers support the value of the device for finding some occult cases, they do not provide data regarding the device's accuracy.…”

“…Of those nearly 11,000 patients in the retrospective review, only 64 had blood COHb levels checked, and those values demonstrated a bias of Ϫ4.2, with limitations of agreement Ϫ16 to 7.5%. 15 No information regarding accuracy or precision was reported in the case series. 16 Other studies indicate that the Rad-57 is less accurate and precise when used in clinical practice.…”

“…[11][12][13]15,17,19,25 The most powerful use of a noninvasive COHb monitor would be to rapidly, accurately, and precisely determine if patients have occult CO toxicity: a simple screening test that reliably determines whether verification of CO toxicity with a blood test is warranted. The performance of the Rad-57 in this pragmatic study by Weaver and colleagues raises doubts about the device's ability to reliably serve that purpose.…”