Hyperbaric Oxygen Therapy in the Treatment of Post Cardiac Surgical Strokes – a Case Series and Review of the Literature

Abstract

Strokes remain an uncommon but significant complication of cardiac surgery. Cerebral air embolism is the likely aetiology in the majority of cases. Hyperbaric oxygen therapy is the recognised treatment for cerebral air embolism associated with compressed air (SCUBA) diving accidents and is therefore also the standard of care for iatrogenic causes of air embolism. It follows that there is a logic in treating post-cardiac surgical stroke patients with hyperbaric oxygen. The aim of this retrospective review was to examine the outcomes of 12 such patients treated in the Christchurch Hospital hyperbaric unit and to appraise the evidence base for the use of hyperbaric oxygen therapy in this setting. Despite delays of up to 48 hours following surgery before the institution of hyperbaric oxygen therapy, 10 of the 12 patients made a full neurological recovery or were left with mild residual symptoms, with nine returning to their previous level of care. One patient remained hemiplegic and there was one early neurological death. There is a paucity of prospective data in this area, but based on sound pathophysiological principles and clinical experience, we believe that patients suffering a stroke following open cardiac surgery should be considered for hyperbaric oxygen therapy.

Hyperbaric Oxygen Therapy for the Adjunctive Treatment of Stroke Associated with Post-Cardiac Surgery Due To Native-Valve Endocarditis Infected by Cutibacterium Acnes: A Case Report

“…Possible mechanisms for the development of post-cardiac surgical strokes include atheromatous plaque fragments dislodged from the aorta during cross-clamping, decreased cerebral perfusion, and gas embolisms [6, 7,13]. Cerebral edema and neuronal apoptosis follow the passage of air bubbles, inducing endothelial damage and an in ammatory response.…”

Delayed hyperbaric oxygen therapy for air emboli after open heart surgery: case report and review of a success story

“…The precise incidence of iatrogenic cerebral arterial air embolism is unknown mostly due to underdiagnosis, underestimation, underreported cases, and seldom non-specific or transient symptomatology [4, 5]. Some previous authors estimated the incidence of 0.1% of all extracorporeal circulation [6].…”

“…Valvular replacement surgery is also a greater risk since the ventricle is opened as opposed to coronary artery bypass grafting [8, 11, 12, 18]. Along that line, another risk factor described is any surgery in which the left ventricle and/or the aorta is opened [5]. …”

The Effect of Hyperbaric Oxygen Therapy on Functional Impairments Caused by Ischemic Stroke

“…The use of HBO as a treatment following stroke was first raised 40-50 years ago [32,51]. Despite decades of interest in HBOT previous studies investigating the effects of HBOT following a stroke have produced mixed results [10,11,18,19,32,40,[52][53][54][55][56][57][58][59][60]. There are a number of variables that may account for the incongruous literature including several related to the study design including the treatment protocol, study population, inclusion of and type of control group, outcomes measured, and timing of treatment.…”