Noninvasive Measurement of Carboxyhemoglobin: How Accurate Is Accurate Enough?

doi:10.1016/j.annemergmed.2010.05.025

Annals of Emergency Medicine

Volume 56, Issue 4, October 2010, Pages 389-391

https://doi.org/10.1016/j.annemergmed.2010.05.025 Get rights and content

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Cited by (24)

Overcoming safety challenges in CO therapy – Extracorporeal CO delivery under precise feedback control of systemic carboxyhemoglobin levels
2018, Journal of Controlled Release
Citation Excerpt :
Current COHb monitoring techniques, however, do not have sufficient accuracy to reliably detect CO intoxication in high dose CO delivery applications: Only pulse oximetry has previously been used for automated, continuous, and real-time quantification of systemic COHb levels [35]. This technique, however, is challenged by a low sensitivity (48% [17,36]) and hence does not provide reliable monitoring and information about systemic CO-levels in high dose CO delivery applications. This is in line with our data showing high variability when correlating COHb (blood gas) with data recorded using pulse oximetry (R2 = 0.37, see Fig. 6C).
Carbon monoxide (CO) has demonstrated therapeutic potential in multiple inflammatory conditions including intensive care applications such as organ transplantation or sepsis. Approaches to translate these findings into future therapies, however, have been challenged by multiple hurdles including handling and toxicity issues associated with systemic CO delivery. Here, we describe a membrane-controlled Extracorporeal Carbon Monoxide Release System (ECCORS) for easy implementation into Extracorporeal Membrane Oxygenation (ECMO) setups, which are being used to treat cardiac and respiratory diseases in various intensive care applications. Functionalities of the ECCORS were investigated in a pig model of veno-arterial ECMO. By precisely controlling CO generation and delivery as a function of systemic carboxyhemoglobin levels, the system allows for an immediate onset of therapeutic CO-levels while preventing CO-toxicity. Systemic carboxyhemoglobin levels were profiled in real-time by monitoring exhaled CO levels as well as by pulse oximetry, enabling self-contained and automatic feedback control of CO generation within ECCORS. Machine learning based mathematical modeling was performed to increase the predictive power of this approach, laying foundation for high precision systemic CO delivery concepts of tomorrow.
Carbon Monoxide Poisoning
2012, Critical Care Clinics
Citation Excerpt :
On the other hand, the difference in arterial saturation observed with pulse oximetry versus an in vitro assessment of oxyhemoglobin saturation (pulse oximetry gap) correlates with the COHb level and may be a cue to raise the suspicion of CO intoxication.52–54 Newly available multiwavelength pulse CO-oximeters have not been reliable for quantifying COHb.49,50 As described, CO lowers the threshold for cardiac ischemia and predisposes to myocardial dysfunction and cardiac arrhythmias18,34,36; therefore, cardiac function must be closely monitored with the use of electrocardiography, echocardiography, and cardiac biomarkers.
The measurement of carboxyhemoglobin and methemoglobin using a non-invasive pulse CO-oximeter
2012, Respiratory Physiology and Neurobiology
Citation Excerpt :
Touger et al. (2010) reported nearly the same sensitivity, although their lower cut-off was a COHb of 15%. In light of this low sensitivity, it has been advocated that the Rad-57 cannot be used to exclude carbon monoxide poisoning in any patient with an appreciable risk of being intoxicated (Maisel and Lewis, 2010). However, since the specificity was 89%, similar to the data from Touger et al. (2010), there is clinical utility for screening of patients to avoid a large number of false-positive tests and also to use it as a first screening on patient with no symptoms with potential carbon monoxide intoxication.
The pulse CO-oximeter (Rad-57 Masimo Corporation, Irvine, CA) allows non-invasive and instantaneous measurement of carboxyhemoglobin (COHb) and methemoglobin (MetHb) percentage level using a finger probe. However, the accuracy and reliability of the Rad-57 against the gold standard of venous or arterial blood samples have not been clearly established. Thus, the objective of this trial is to evaluate the accuracy and precision of the Rad-57 pulse CO-oximeter by comparing it with venous sampling on the same subjects. Nine healthy subjects were subjected to carbon monoxide such that it raised the COHb to 10–14% on two different days and pooled together. The COHb and MetHb were measured with a blood gas-analyzer and simultaneously with the Rad-57 as the COHb increased from 1.4 to 14%. Results were compared using linear regression and a Bland and Altman method comparison. Mean bias and precision for COHb measured with the Rad-57 was −1% and 2.5%, respectively. The mean bias and precision for MetHb measured with the Rad-57 was 0.0% and 0.3%, respectively. The ability to detect a COHb ≥10% occurred in 54% of the samples in which COHb was ≥10–14%. In conclusion, the Rad-57 provides a reading that is between −6% and +4% of the true COHb value for 95% of all samples. The Rad-57 seems to be a good substitute as a first screening test of COHb when the pulse CO-oximeter reads <15%.
Performance of the rad-57 pulse Co-oximeter compared with standard laboratory carboxyhemoglobin measurement
2010, Annals of Emergency Medicine
Diagnostic accuracy of carboxyhemoglobin saturation with pulse CO-oximetry in patients with carbon monoxide poisoning
2023, Toxicology Research
Evaluation of a Portable Blood Gas Analyzer for Prehospital Triage in Carbon Monoxide Poisoning: Instrument Validation Study
2023, JMIR Formative Research

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: Supervising editor: Lewis S. Nelson, MD

: Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article that might create any potential conflict of interest. The authors have stated that no such relationships exist. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. Dr. Maisel is an FDA consultant. The article represents the opinions of the authors and does not necessarily represent the practices, policies, or positions of the FDA.

: Reprints not available from the authors.

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Toxicology/editorialNoninvasive Measurement of Carboxyhemoglobin: How Accurate Is Accurate Enough?

J Emerg Med

Ann Emerg Med

Unintentional non-fire-related carbon monoxide exposures—United States, 2001-2003

MMWR Morb Mortal Wkly Rep

Carbon monoxide poisoning

N Engl J Med

Masimo Rad-57

K042536—Masimo Rainbow SET Rad 57 pulse CO-oximeter. 510(k) Summary

Comparison of the Masimo Rad-57 pulse oximeter with SpCO technology against a laboratory CO-oximeter using arterial blood

Respir Care

Toxicology/editorial
Noninvasive Measurement of Carboxyhemoglobin: How Accurate Is Accurate Enough?