Hyperbaric oxygen for blast‐related postconcussion syndrome: Three‐month outcomes

Cifu, David X.; Walker, William C.; West, Steven L.; Hart, Brett; Franke, Laura Manning; Sima, Adam P.; Graham, Carolyn W.; Carne, William

doi:10.1002/ana.24067

Cited by 45 publications

(67 citation statements)

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“…Five relevant studies [5][6][7][8][9] were found and analyzed as shown in Table 1 (based on Levels of Evidence, Centre for Evidence Based Medicine, 2009). Wolf et al 5 concluded that there was no effect on postconcussion symptoms after an HBOT treatment (2.4 atmospheres absolute [ATA] breathing 100% oxygen) compared with the sham group (1.3 ATA breathing 21% oxygen).…”

Section: Results Of Searchmentioning

confidence: 99%

“…The treatment parameters and results were similar, with subsequent studies measuring eye movements 7 and 3-month outcomes. 8 Boussi-Gross et al 9 concluded that HBOT treatment (1.5 ATA breathing 100% oxygen) can be used to improve quality of life and cognitive function in patients suffering from postconcussion syndrome.…”

Section: Results Of Searchmentioning

confidence: 99%

“…To be classified as postconcussion syndrome, participants had to still be suffering symptoms associated with the mild traumatic brain injury for a minimum of 3 months. 5 The Wolf et al 5 study did not indicate a length of time since the injury occurred, the 3 Cifu et al [6][7][8] articles indicated within the last 3 years, and the Boussi-Gross et al 9 study allowed up to 6 years. In addition, the articles treated with differing parameters, as outlined in the previous paragraph.…”

Section: Results Of Searchmentioning

confidence: 99%

“…In addition, the articles treated with differing parameters, as outlined in the previous paragraph. It is interesting to note that the treatment used by BoussiGross et al 9 was the same as the sham treatment in the Cifu et al [6][7][8] studies. Perhaps there are therapeutic properties associated with lesser ATA that have not been ascertained as of yet.…”

Section: Results Of Searchmentioning

confidence: 99%

“…[5][6][7][8] • Only 1 study supported the use of HBOT, providing evidence that HBOT can improve brain function in people with postconcussion syndrome. 9…”

Section: Focused Clinical Questionmentioning

confidence: 99%

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The Effectiveness of Hyperbaric Oxygen Therapy as a Treatment for Postconcussion Symptoms

Hawkins¹,

Gonzalez²,

Heumann³

2017

Journal of Sport Rehabilitation

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Clinical Scenario: Concussions are a prevalent topic in medicine. Concussion symptoms include headaches, dizziness, nausea, neuropsychiatric symptoms, and cognitive impairments, the persistence of which is referred to as postconcussion syndrome. Hyperbaric oxygen therapy (HBOT) has been proposed and evaluated as an additional treatment of these symptoms. HBOT is an innovative approach that has been considered by many but has received both criticism and acceptance. Clinical Question: Is HBOT an effective means of reducing symptoms for individuals suffering from postconcussion syndrome (persistence of symptoms for >3 mo)? Summary of Search: The literature was searched for studies that were relevant to the clinical question. Literature provided 5 level 1 studies that were relevant enough to be considered. Clinical Bottom Line: Based on the research that is available, the authors conclude that there is more evidence to refute the use of HBOT for postconcussion syndrome than to support it. Strength of Recommendation: Four studies disprove the use of HBOT; 1 study supported the use of HBOT. These 5 studies are the same level of evidence (level 1) and provide significant findings in their studies. The strength of this recommendation is a B according to the Centre for Evidence-Based Medicine. Keywords: therapeutic modality, atmospheric pressure, mild traumatic brain injury Clinical ScenarioConcussions are a prevalent topic in medicine. Researchers and clinicians are striving to improve the treatment, care, and side effects of concussions. Concussion symptoms include headaches, dizziness, nausea, neuropsychiatric symptoms, and cognitive impairments. The persistence of these symptoms for more than 3 months is known as postconcussion syndrome. 1 Hyperbaric oxygen therapy (HBOT) has been proposed and evaluated as a viable treatment for postconcussion syndrome.The theoretical basis behind the use of HBOT resides in a damaged cell's need for oxygen. 2 Under ideal circumstances the red blood cells in the blood stream are nearly 100% saturated with oxygen. The plasma also has oxygen-carrying capacity but typically carries very little. 3 A hyperbaric chamber treatment, consisting of an increase in atmospheric pressure while breathing 100% oxygen, can force oxygen into the plasma, resulting in greater oxygen delivery to the tissues. 4 With greater amounts of oxygen available, the damaged cells can theoretically heal faster. 2 HBOT is an innovative approach for postconcussion syndrome that has been considered by many but has received equal amounts of criticism and acceptance. Focused Clinical QuestionIs HBOT an effective means of reducing symptoms for individuals suffering from postconcussion syndrome?Summary of Search, "Best Evidence" Appraised, and Key Findings Clinical Bottom LineBased on the research reviewed, we conclude that more studies refute the use of HBOT for postconcussion syndrome than support it, so the clinical use of HBOT to treat postconcussion symptoms/syndrome should be questioned. The comparison of the article...

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Section: Results Of Searchmentioning

confidence: 99%

Section: Results Of Searchmentioning

confidence: 99%

Section: Results Of Searchmentioning

confidence: 99%

Section: Results Of Searchmentioning

confidence: 99%

“…[5][6][7][8] • Only 1 study supported the use of HBOT, providing evidence that HBOT can improve brain function in people with postconcussion syndrome. 9…”

Section: Focused Clinical Questionmentioning

confidence: 99%

See 3 more Smart Citations

The Effectiveness of Hyperbaric Oxygen Therapy as a Treatment for Postconcussion Symptoms

Hawkins¹,

Gonzalez²,

Heumann³

2017

Journal of Sport Rehabilitation

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Effects of Hyperbaric Oxygen on Symptoms and Quality of Life Among Service Members With Persistent Postconcussion Symptoms

et al. 2015

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Improvement has been anecdotally observed in patients with persistent postconcussion symptoms (PCS) after mild traumatic brain injury following treatment with hyperbaric oxygen (HBO). The effectiveness of HBO as an adjunctive treatment for PCS is unknown to date. OBJECTIVES To compare the safety of and to estimate the efficacy for symptomatic outcomes from standard PCS care alone, care supplemented with HBO, or a sham procedure. DESIGN, SETTING, AND PARTICIPANTS Multicenter, double-blind, sham-controlled clinical trial of 72 military service members with ongoing symptoms at least 4 months after mild traumatic brain injury enrolled at military hospitals in Colorado, North Carolina, California, and Georgia between April 26, 2011, and August 24, 2012. Assessments occurred before randomization, at the midpoint, and within 1 month after completing the interventions. INTERVENTIONS Routine PCS care was provided in specialized clinics. In addition, participants were randomized 1:1:1 to 40 HBO sessions administered at 1.5 atmospheres absolute (ATA), 40 sham sessions consisting of room air at 1.2 ATA, or no supplemental chamber procedures. MAIN OUTCOMES AND MEASURES The Rivermead Post-Concussion Symptoms Questionnaire (RPQ) served as the primary outcome measure. A change score of at least 2 points on the RPQ-3 subscale (range, 0-12) was defined as clinically significant. Change scores from baseline were calculated for the RPQ-3 and for the total RPQ. Secondary measures included additional patient-reported outcomes and automated neuropsychometric testing. RESULTS On average, participants had sustained 3 lifetime mild traumatic brain injuries; the most recent occurred 23 months before enrollment. No differences were observed between groups for improvement of at least 2 points on the RPQ-3 subscale (25% in the no intervention group, 52% in the HBO group, and 33% in the sham group; P = .24). Compared with the no intervention group (mean change score, 0.5; 95% CI, −4.8 to 5.8; P = .91), both groups undergoing supplemental chamber procedures showed improvement in symptoms on the RPQ (mean change score, 5.4; 95% CI, −0.5 to 11.3; P = .008 in the HBO group and 7.0; 95% CI, 1.0-12.9; P = .02 in the sham group). No difference between the HBO group and the sham group was observed (P = .70). Chamber sessions were well tolerated. CONCLUSIONS AND RELEVANCE Among service members with persistent PCS, HBO showed no benefits over sham compressions. Both intervention groups demonstrated improved outcomes compared with PCS care alone. This finding suggests that the observed improvements were not oxygen mediated but may reflect nonspecific improvements related to placebo effects. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01306968

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Blood Biomarkers for Brain Injury in Concussed Professional Ice Hockey Players

et al. 2014

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IMPORTANCE Lack of objective biomarkers for brain damage hampers acute diagnosis and clinical decision making about return to play after sports-related concussion. OBJECTIVES To determine whether sports-related concussion is associated with elevated levels of blood biochemical markers of injury to the central nervous system and to assess whether plasma levels of these biomarkers predict return to play in professional ice hockey players with sports-related concussion. DESIGN, SETTING, AND PARTICIPANTS Multicenter prospective cohort study involving all 12 teams of the top professional ice hockey league in Sweden, the Swedish Hockey League. Two hundred eighty-eight professional ice hockey players from 12 teams contesting during the 2012-2013 season consented to participate. All players underwent clinical preseason baseline testing regarding concussion assessment measures. Forty-seven players from 2 of the 12 ice hockey teams underwent blood sampling prior to the start of the season. Thirty-five players had a concussion from September 13, 2012, to January 31, 2013; of these players, 28 underwent repeated blood sampling at 1, 12, 36, and 144 hours and when the players returned to play. MAIN OUTCOMES AND MEASURES Total tau, S-100 calcium-binding protein B, and neuron-specific enolase concentrations in plasma and serum were measured. RESULTS Concussed players had increased levels of the axonal injury biomarker total tau (median, 10.0 pg/mL; range, 2.0-102 pg/mL) compared with preseason values (median, 4.5 pg/mL; range, 0.06-22.7 pg/mL) (P < .001). The levels of the astroglial injury biomarker S-100 calcium-binding protein B were also increased in players with sports-related concussion (median, 0.075 μg/L; range, 0.037-0.24 μg/L) compared with preseason values (median, 0.045 μg/L; range, 0.005-0.45 μg/L) (P < .001). The highest biomarker concentrations of total tau and S-100 calcium-binding protein B were measured immediately after a concussion, and they decreased during rehabilitation. No significant changes were detected in the levels of neuron-specific enolase from preseason values (median, 6.5 μg/L; range, 3.45-18.0 μg/L) to postconcussion values (median, 6.1 μg/L; range, 3.6-12.8 μg/L) (P = .10). CONCLUSIONS AND RELEVANCE Sports-related concussion in professional ice hockey players is associated with acute axonal and astroglial injury. This can be monitored using blood biomarkers, which may be developed into clinical tools to guide sport physicians in the medical counseling of athletes in return-to-play decisions.

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Hyperbaric oxygen for blast‐related postconcussion syndrome: Three‐month outcomes

Abstract: Using a randomized control trial design and analysis including a sham, results showed no evidence of efficacy by 3 months post-compression to treat the symptomatic, cognitive, or behavioral sequelae of PCS after combat-related mTBI.

Cited by 45 publications

References 58 publications

The Effectiveness of Hyperbaric Oxygen Therapy as a Treatment for Postconcussion Symptoms

The Effectiveness of Hyperbaric Oxygen Therapy as a Treatment for Postconcussion Symptoms

Effects of Hyperbaric Oxygen on Symptoms and Quality of Life Among Service Members With Persistent Postconcussion Symptoms

Blood Biomarkers for Brain Injury in Concussed Professional Ice Hockey Players

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