The Undersea Hyperbaric Medical Society (UHMS) has just reconsidered its original opinion on the use of Hyperbaric Oxygen Therapy to treat patients with COVID-19. They now support the compassionate care use of HBOT for COVID-19 in their new position statement entitled, “Rationale, Study Design Considerations, And Protocol Recommendations For Treating Covid-19 Patients With Hyperbaric Oxygen.”
As SARS-CoV-2 infection accelerated in early 2020, many patients deteriorated rapidly and became ventilator-dependent. The death rate from serious infection was frightening, especially in patients with other chronic diseases. Clinicians and medical researchers began developing strategies to treat and prevent this new worldwide public health threat. They looked to novel interventions because no highly effective therapies existed, and care was mostly supportive. Some recommended hyperbaric oxygen (HBO2) therapy because of its demonstrated success in providing oxygen and reducing end-organ damage in patients with severe carbon monoxide poisoning or anemia. A publication from China reported dramatic results in five critically ill patients treated with HBO2 [1]. A second case series published by Thibodeaux, et al. [2]. showed that patients who received hyperbaric oxygen at a critical junction when intubation seemed imminent avoided intubation. Gorenstein and colleagues have now reported in a publication in pre-print form a series of 20 patients treated with hyperbaric oxygen and compared to propensity matched controls. They conclude that HBO2 is safe and possibly effective. [3] Additional anecdotal reports appeared to show an impressive improvement in sick patients even in the setting of progressive respiratory failure despite delivery of prolonged high FiO2s (fraction of inspired oxygen). One of our committee members based on her personal experiences in treating a small group of patients has suggested utility in using transcutaneous oxygen in monitoring patients’ responses to hyperbaric oxygen, including the continued use of this technology after a hyperbaric treatment and return of the patient to the ICU [4]. Two prior publications had reported experiences in applying transcutaneous oxygen measurements as a monitoring tool to be applied to critically ill patients [5,6].
With these reported successes interest in the possible role of hyperbaric oxygen in COVID-19 treatment increased. The Undersea and Hyperbaric Medical Society (UHMS) was called upon to render an opinion, and a UHMS Policy Statement. The Society initially supported treatment only when patients were enrolled in clinical trials approved by an Institutional Review Board (IRB). Subsequent to that initial position statement the UHMS has conducted a webinar reporting likely mechanisms and early clinical experiences. Two prominent hyperbaric experts authored an editorial discussing the major issues of applying hyperbaric oxygen to the treatment of COVID-19 patients [7]. An even more recent paper by Paganini et al. discusses the biological mechanisms of action of hyperbaric oxygen and identifies potential logistic difficulties and toxicities of treatment [8].
The incidence of COVID-19 has increased dramatically, and this unfortunate abundance of patients has led to a significant understanding of what treatments are effective and which are not. Much of this evolution in treatment has been in the utilization of a known technology in a novel application. The UHMS has, therefore, reconsidered its position on the compassionate use of hyperbaric oxygen for COVID patients based on the strong mechanistic evidence and from the impressive results in the patients reported to date. We encourage the enrollment of patients in formal, IRB-approved clinical trials and would prefer that they be randomized and controlled. Given the dire and widespread implications of the spreading pandemic and the absence of highly effective therapies, we recognize and support single-armed studies and the compassionate application of hyperbaric oxygen when an IRB approved protocol cannot be reasonably obtained.
The UHMS goes on to make recommendations for study parameters as well as provide a patient consent template. You can read the full article here: https://www.uhms.org/images/MiscDocs/Rational_and_study_design_for_treating_COVID_patients_with_HBO2.pdf