HBOT in TBI & Coma

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Thousands of Americans suffer brain damage as the result of near-hanging, near-drowning, near-choking, cardiac arrest, cyanide and carbon monoxide poisonings, and lightning strikes every year (150,000 Americans suffer severe head injuries just from trauma alone). This type of brain damage is known as an anoxic ischemic encephalopathy. It is both the size and the location of the irreparable damage (the umbra), as well as the reversibility of the damage within the surrounding brain tissue (the penumbra), that dictates the patient's prognosis.

Brain damage occurs after a head injury because, more often than not, the brain starts to swell, pressing delicate tissue against the unyielding skull. This swelling then cuts off the brain's blood supply, which leads the accumulation of toxic levels of normal cell wastes, which further aggravate the swelling. Such damage can lead to coma, a state of deep unconsciousness in which one does not respond to pain or sound, and cannot be awakened.

HBOT has the potential to break this cycle by constricting the brain's blood vessels, while delivering more oxygen. This seems like a paradox, but HBOT can increase oxygen levels because the increased pressure forces oxygen into the blood plasma, the liquid part of the blood that normally does not carry oxygen, and into the cerebrospinal fluid that surrounds the brain. The plasma and cerebrospinal fluid can then reach areas that the red blood cells, which normally carry oxygen, cannot penetrate. Giving a patient pure oxygen at normal pressure simply cannot put enough oxygen into either the bloodstream or the cerebrospinal fluid to overcome the oxygen deficit.

HBOT can also stabilize and repair what is called the blood-brain barrier, a protective layer of cells that keeps many toxins or noxious materials from reaching the brain. This barrier is often greatly disturbed when a head injury occurs.

In the immortal words of Dr. P.B. James, MB, ChB, DIH, PhD, FFOM, of the Wolfson Hyperbaric Medicine Unit, University of Dundee, "Those wanting to find out more about oxygen treatment will be disappointed that some professionals do not appear to be open minded. A head injury may close the mind, but hyperbaric oxygenation has been shown in a controlled trial to reduce the mortality of head injury by 50%. (Rockswold GL et al J Neurosurg see abstract below). Determine the knowledge of this therapy of a health professional by first asking if they know this paper. If they do not then move on. If they do then ask:"

 

Abstract

Results of a prospective randomized trial for treatment of severely brain-injured patients with hyperbaric oxygen

Authors: Rockswold GL , Ford SE , Anderson DC , Bergman TA , Sherman RE
Division of Neurosurgery, Hennepin County Medical Center, Minneapolis, Minnesota.
J Neurosurg 1992 Jun;76(6):929-34

Abstract: The authors enrolled 168 patients with closed-head trauma into a prospective trial to evaluate the effect of hyperbaric oxygen in the treatment of brain injury. Patients were included if they had a total Glasgow Coma Scale (GCS) score of 9 or less for at least 6 hours. After the GCS score was established and consent obtained, the patient was randomly assigned, stratified by GCS score and age, to either a treatment or a control group. Hyperbaric oxygen was administered to the treatment group in a monoplace chamber every 8 hours for 1 hour at 1.5 atm absolute; this treatment course continued for 2 weeks or until the patient was either brain dead or awake. An average of 21 treatments per patient was given. Outcome was assessed by blinded independent examiners. The entire group of 168 patients was followed for 12 months, with two patients lost to follow-up study. The mortality rate was 17% for the 84 hyperbaric oxygen-treated patients and 32% for the 82 control patients (chi-squared test, 1 df, p = 0.037). Among the 80 patients with an initial GCS score of 4, 5, or 6, the mortality rate was 17% for the hyperbaric oxygen-treated group and 42% for the controls (chi-squared test, 1 df, p = 0.04). Analysis of the 87 patients with peak intracranial pressures (ICP) greater than 20 mm Hg revealed a 21% mortality rate for the hyperbaric oxygen-treated patients, as opposed to 48% for the control group (chi-squared test, 1 df, p = 0.02). Myringotomy to reduce pain during hyperbaric oxygen treatment helped to reduce ICP. Analysis of the outcome of survivors reveals that hyperbaric oxygen treatment did not increase the number of patients in the favorable outcome categories (good recovery and moderate disability). The possibility that a different hyperbaric oxygen treatment paradigm or the addition of other agents, such as a 21-aminosteroid, may improve quality of survival is being explored.