Carbon Monoxide Exposure in Youth Ice Hockey

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To examine the effect of ice resurfacer type on carboxyhemoglobin levels in youth hockey players. We hypothesized that players in arenas with electric resurfacers would have normal, stable carboxyhemoglobin levels during games, whereas those in arenas with internal combustion engine (IC) resurfacers would have an increase in carboxyhemoglobin levels.


Prospective cohort study.


Enclosed ice arenas in the northeastern United States.


Convenience sample of players aged 8 to 18 years old in 16 games at different arenas. Eight arenas (37 players) used an IC ice resurfacer and 8 arenas (36 players) an electric resurfacer.


Carboxyhemoglobin levels (SpCO) were measured using a pulse CO-oximeter before and after the game. Arena air was tested for carbon monoxide (CO) using a metered gas detector. Players completed symptom questionnaires.

Main Outcome Measures:

The change in SpCO from pregame to postgame was compared between players at arenas with electric versus IC resurfacers.


Carbon monoxide was present at 6 of 8 arenas using IC resurfacers, levels ranged from 4 to 42 parts per million. Carbon monoxide was not found at arenas with electric resurfacers. Players at arenas with IC resurfacers had higher median pregame SpCO levels compared with those at electric arenas (4.3% vs 1%, P < 0.01). Players in the IC group also had a significant increase in their SpCO level during a hockey game compared with those in the electric group (2.8% vs 1%, P = 0.01). There were no significant differences in symptom scores.


Players at arenas operating IC resurfacers had significantly higher SpCO levels.

Clinical Relevance:

Youth hockey players in arenas with IC resurfacers have an increase in carboxyhemoglobin during games and have elevated baseline carboxyhemoglobin levels compared with players at arenas with electric resurfacers. Electric resurfacers decrease the risk of CO exposure.

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