Hyperbaric oxygen therapy for COVID-19 patients with respiratory distress: treated cases versus propensity-matched controls

Abstract

Objective: Given the high mortality and prolonged duration of mechanical ventilation of COVID-19 patients, we evaluated the safety and efficacy of hyperbaric oxygen for COVID-19 patients with respiratory distress. Methods: This is a single-center clinical trial of COVID-19 patients at NYU Winthrop Hospital from March 31 to April 28, 2020. Patients in this trial received hyperbaric oxygen therapy at 2.0 atmospheres of pressure in monoplace hyperbaric chambers for 90 minutes daily for a maximum of five total treatments. Controls were identified using propensity score matching among COVID-19 patients admitted during the same time period. Using competing-risks survival regression, we analyzed our primary outcome of inpatient mortality and secondary outcome of mechanical ventilation. Results: We treated 20 COVID-19 patients with hyperbaric oxygen. Ages ranged from 30 to 79 years with an oxygen requirement ranging from 2 to 15 liters on hospital days 0 to 14. Of these 20 patients, two (10%) were intubated and died, and none remain hospitalized. Among 60 propensity-matched controls based on age, sex, body mass index, coronary artery disease, troponin, D-dimer, hospital day, and oxygen requirement, 18 (30%) were intubated, 13 (22%) have died, and three (5%) remain hospitalized (with one still requiring mechanical ventilation). Assuming no further deaths among controls, we estimate that the adjusted subdistribution hazard ratios were 0.37 for inpatient mortality (p=0.14) and 0.26 for mechanical ventilation (p=0.046). Conclusions: Though limited by its study design, our results demonstrate the safety of hyperbaric oxygen among COVID-19 patients and strongly suggests the need for a well-designed, multi-center randomized control trial.

Prevention and Treatment of Life-Threatening COVID-19 May Be Possible with Oxygen Treatment

“…All these studies state that HBOT is a safe and promising alternative for the treatment of COVID-19 patients. Some studies specifically describe patients reporting the prompt resolution of labored breathing following a single HBOT treatment [ 81 , 82 , 83 , 84 , 85 ]. In one very recent study, aimed at becoming RCT-compatible, it was possible to correct severe hypoxemia with mild HBOT (0.45 ATA overpressure) in three days compared with nine days in the controls [ 86 ].…”

“…The authors of COVID-19-HBOT studies conclude in common that well-defined RCT-compatible clinical trials are urgently needed [ 82 , 83 , 84 , 85 , 86 ]. However, designing such a trial may be difficult.…”

COVID-19 infection prevention and control management during hyperbaric oxygen therapy: a best practice implementation project

“…A significant number of severely ill patients progressed to intensive care units, with some patients requiring mechanical ventilation, ECMO, and other aggressive interventions. Some alternative therapeutic approaches to address COVID-19-associated hypoxia have been identified, such as hyperbaric oxygen therapy (HBOT) 2–4 . HBOT involves short-term inhalation systemic therapy with high doses of oxygen.…”

Video_1.mov

“…Using a converted boiler as a hyperbaric chamber in Kansas City, Missouri (altitude 909 ft), Cunningham replicated this improvement caused by altitude descent on human disease when he treated an agonal Spanish flu patient in 1918, achieving complete recovery with four daily 1-h 1.6 ATA hyperbaric air treatment (HBAT) sessions (6, 7) Countless Spanish flu patients followed, and Cunningham extended his clinical treatment benefits to a variety of conditions (7)(8)(9). After a hundred years, his reasoning and success were replicated in the application of hyperbaric oxygen therapy (HBOT) to COVID-19 (10)(11)(12) . and post-COVID "Long Haulers Syndrome."…”