Cyanide poisoning by fire smoke inhalation: a European expert consensus

Eur J Emerg Med. 2013 Feb;20(1):2-9. doi: 10.1097/MEJ.0b013e328357170b.


Smoke inhalation is a common cause of cyanide poisoning during fires, resulting in injury and even death. In many cases of smoke inhalation, cyanide has increasingly been recognized as a significant toxicant. The diagnosis of cyanide poisoning remains very difficult, and failure to recognize it may result in inadequate or inappropriate treatment. Findings suggesting cyanide toxicity include the following: (a) a history of enclosed-space fire; (b) any alteration in the level of consciousness; (c) any cardiovascular changes (particularly inexplicable hypotension); and (d) elevated plasma lactate. The feasibility and safety of empiric treatment with hydroxocobalamin for fire smoke victims have been reported in the literature. On the basis of a literature review and a panel discussion, a group of European experts has proposed emergency management protocols for cyanide toxicity in fire smoke victims.

Publication types

  • Consensus Development Conference

MeSH terms

  • Algorithms
  • Chemical Warfare Agents / poisoning*
  • Clinical Protocols
  • Delphi Technique
  • Emergency Medical Services
  • Europe
  • Hematinics / therapeutic use
  • Humans
  • Hydrogen Cyanide / poisoning*
  • Hydroxocobalamin / therapeutic use
  • Smoke / analysis
  • Smoke Inhalation Injury / complications*
  • Smoke Inhalation Injury / drug therapy


  • Chemical Warfare Agents
  • Hematinics
  • Smoke
  • Hydrogen Cyanide
  • Hydroxocobalamin