Smoke Inhalation and Cyanide Poisoning: 20 Years of Paris Experience

Hydroxocobalamin has been used as a cyanide poisoning antidote for many years in France. It has recently been approved by the US FDA. In Paris, hydroxocobalamin is carried by the Brigade de Sapeurs Pompiers (Paris Fire Brigade) in mobile intensive care vehicles and has been administered empirically to victims of enclosed-space fire smoke inhalation who meet the criteria of having soot in the nose, mouth, or throat, any alteration in mental status or disturbance in consciousness, and especially if any degree of hypotension is present (BP less than or equal to 100 mmHg systolic). The administration of hydroxocobalamin at the scene was shown to be safe. Hydroxocobalamin has also been efficacious and safe in 'pure' cyanide poisoning, as long as brain death has not already occurred. A 'toxidrome' of cyanide poisoning has been developed in our institution in Paris, and its application can assist in making the diagnosis of this life-threatening poisoning which cannot be emergent diagnosed by currently-available laboratory methods.(author)