Seizure during hyperbaric oxygen therapy: experience at a single academic hospital in Korea

Abstract

Background: Hyperbaric oxygen (HBO2) therapy is a safe and well-tolerated treatment modality. Seizures, one of the most severe central nervous system side effects of HBO2 therapy, can occur. Episodes of seizures during HBO2 therapy have not yet been reported in countries such as Korea, where hyperbaric medicine is still in the developmental stage. Methods: The registry data of all patients treated with HBO2 therapy in a tertiary academic hospital in Korea were prospectively collected, and patients who developed seizures during HBO2 therapy between October 2016 and December 2019 were evaluated. In addition, we reviewed previous studies on occurrence of seizures during HBO2 therapy. Results: During the study period, a total of 10,425 treatments were provided to 1,308 patients. The most frequently treated indication was carbon monoxide (CO) poisoning ABSTRACT (n=547, 41.8%). During the HBO2 therapy sessions (total: 10,425), five seizure episodes occurred (patients with CO poisoning: n=4; patients with arterial gas embolism [AGE]: n=1). The frequency of seizures in patients with CO poisoning (0.148%) and AGE (3.448%) was significantly higher than that in patients with all indications (0.048%) (p=0.001). None of the patients had lasting effects due to the seizures. Conclusion: Our study revealed a similar frequency rate in terms of all indications and CO poisoning, and a slightly higher rate in AGE. Seizures were observed in patients with CO poisoning and AGE. Therefore, if clinicians plan to operate a hyperbaric center in a country like Korea, where there are several patients with acute CO poisoning, they should be prepared to handle seizures that may occur during HBO2 therapy.

A man in his sixties with acute chest pain

“…tilstrekkelig vurdert, viste følgende: pH 7,40 (7,44), pO2 9,0 kPa (10,(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)0), pCO2 4,8 kPa (4,7-6,0), HbCO 27,4 % (0-1,5) og laktat 1,5 mmol/L (0,5-2,2). Det forelå altså en betydelig forhøyet karbonmonoksidtensjon, som uheldigvis ble oversett initialt.…”

“…Selv om behandlingen i moderne trykkammer stort sett er trygg, er all hyperbar behandling forbundet med en viss risiko for barotraumer (øre-og bihuleskader, pneumotoraks) og oksygentoksisitet (12,13). Hyperbar oksygenbehandling brukes fortsatt i Norge, men tendensen er å vaere restriktiv med hvem som tilbys denne behandlingen.…”

“…Han CT-undersøkelse av aorta viste ingen tegn til aortapatologi. Blodprøver tatt umiddelbart etter innleggelse viste følgende: leukocytter 12,4 × 109/L (referanseområde 3,5-10,0 × 109/L), hemoglobin 14,8 g/dL (13,(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)0), CRP < 0,6 mg/L (< 5,0), kreatinin 74 µmol/L (60-105) og troponin T 28 ng/L (0-14). Det var altså avvik kun for troponin T. Således konkluderte man med diagnosen sannsynlig akutt hjerteinfarkt uten ST-elevasjon, selv om diagnosen akutt hjerteinfarkt ikke kan settes ut fra én enkeltstående troponinverdi.…”

Adverse Events During Hyperbaric Oxygen Therapy – Literature Review

“…None of the patients had lasting effects due to the seizures. Seizures have been observed in patients with CO and AGE poisoning [21].…”