Hi Everyone, my name is Brent Dibble and along with Ben Cunningham, I will be presenting the article “Therapeutic Red

Cell Exchange for Severe Carbon Monoxide Poisoning.” Let’s start with some general background information. Carbon monoxide poisoning is responsible for 2,700 deaths in the US annually and is the most common cause of death from poisoning worldwide. CO displacement of oxygen from hemoglobin causes decreased oxygen delivery and results in tissue hypoxia. Diagnosis is largely dependent on history, but can also be determined from high carboxyhemoglobin levels. Therapy obviously begins with environment modification and removal of the patient from the exposure. The patient is given supplemental O2 and any additional supportive care they may need. In severe cases, a hyperbaric oxygen chamber can be used to aid with treatment. However, this technology is quite expensive and not readily available at many non-metropolitan hospitals. An additional technique, therapeutic red cell exchange, has been suggested as a lower cost alternative. There have been multiple studies examining its efficacy, but most are individual case studies or deal with lower carboxyhemoglobin levels. In this paper, the authors sought to determine the efficacy of TREX therapy in treating patients with severe carbon monoxide poisoning. Study design:  They performed a restrospective chart review on 120 patients seen in an ED for carbon monoxide poisoning  From these 120, they screened for patients with severe CO poisoning (defined as >35% carboxyhemoglobin) and who were treated with TREX. They found 12. o TREX was performed in patients who:  Had been admitted with a GCS <10 and with COHb >35; and  Whose GCS did not recover as a result of standard therapy  They recorded gender, age, time of arrival at the hospital, pretreatment GSC and COHb, duration of TREX< amount of RBCs used for TREX, post treatment GSC and COHb, complications and clinical outcomes. What is TREX? Red blood cell exchange apheresis, also known as therapeutic erythrocytapheresis, is a nonsurgical therapy that removes and replaces a patient's red blood cells.

which are responsible for carrying oxygen to all parts of the body. Red blood cell exchange apheresis involves removing blood through a needle or catheter and circulating it through a machine where the blood is separated into red cells. are discarded and replaced with red blood cells provided by a blood donor. The donor red blood cells circulate back to the patient with the other blood components (white cells. white cells. platelets and plasma. The red cells. platelets and plasma) through a return needle.The Cobe Spectra is used for Red Cell Exchange Apheresis. .

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