For victims of house fires, the risk of death is directly related to exposure to cyanide – a component of smoke.

Hydroxocobalamin, a natural vitamin B12 derivative and antidote for cyanide poisoning, has been used in smoke inhalation patients in the United States since 2006. However, no studies have evaluated hydroxocobalamin versus no antidotal intervention, and there is no consensus on its use as a first–line treatment for suspected cyanide toxicity.

In a study published in the February issue of the journal Burns, Lyly Nguyen, MD, and colleagues compared the outcomes of patients at Vanderbilt who received hydroxocobalamin (2008–2014) to historical control patients who did not (2002–2008).

Mortality rates were similar for the two groups, and patients who received hydroxocobalamin had lower rates of pneumonia, increased ventilator–free days and shorter intensive care unit stays compared to control patients.

Burn centers should consider routine use of hydroxocobalamin in patients with suspected smoke inhalation injury, the authors suggest.