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Hyperbaric Oxygen Therapy for Brain Injury, Cerebral Palsy, and Stroke
Evidence Reports/Technology Assessments, No. 85
Marian S McDonagh, PharmD, Principal Investigator, Susan Carson, MPH, Joan S Ash, MLS, MBA, PhD, Barry S Russman, MD, P Zoë Stavri, PhD, Kathryn Pyle Krages, AMLS, MA, and Mark Helfand, MD, MS, EPC Director.
Structured Abstract
Objectives:
The purpose of this report is to describe the methods, results, and conclusions of a literature review of the benefits and harms of hyperbaric oxygen therapy (HBOT) for brain injury, cerebral palsy, and stroke.
Search Strategy:
We searched MEDLINE, PreMEDLINE, EMBASE, CINAHL, the Cochrane Library, the Health Technology Assessment Database, HealthSTAR, AltHealthWatch and MANTIS from inception to March 2001, using terms for hyperbaric oxygen therapy, brain injury, cerebral palsy, and stroke. We also searched additional databases recommended by experts, meeting abstracts, conference proceedings, and reference lists. Peer reviewers and reference lists of included studies were queried for additional studies. The search was updated in February 2002, and July 2003.
Selection Criteria:
Two reviewers independently assessed each title and abstract using predetermined inclusion criteria based on intervention, population, outcome measures, and study design criteria. Full papers, reports, and meeting abstracts that met inclusion criteria were retrieved and reviewed independently by two reviewers.
Data Collection and Analysis:
Extraction of data from studies was performed by one reviewer and checked by a second reviewer. Each study was assessed for quality using predetermined criteria. An overall assessment of each body of literature was made based on the internal and external validity, and consistency and coherence of the results of studies.
Main Results:
For traumatic brain injury, the evidence about effectiveness is conflicting. One trial found a significant decrease in mortality, associated with an increase in severe disability among those who survived. The other found no difference overall, but a significant reduction in mortality in one subgroup. Together, these studies provided insufficient evidence to determine whether the benefits of HBOT outweigh the potential harms. For other types of brain injury, no good- or fair-quality studies were found. For cerebral palsy, the results of the only truly randomized trial were difficult to interpret because of the use of pressurized room air in the control group. Patients who received HBOT and those who received pressurized air improved to a similar degree. No controlled trial of HBOT was designed to measure mortality in stroke patients, and the best studies found no improvement in neurological outcomes. Evidence about the type, frequency, and severity of adverse events in actual practice is inadequate. Reporting of adverse effects was limited, and no study was designed specifically to assess adverse effects.
Conclusions:
Evidence from well-conducted clinical studies is limited. The balance of benefits and harms of HBOT for brain injury, cerebral palsy, or stroke has not been adequately studied. Future research of HBOT should include dose-ranging and safety studies to establish the optimum course of HBOT to evaluate in outcome studies. Future clinical trials should include several treatment options and should evaluate measure caregiver burden in addition to patients' functional outcomes.
Contents
- Preface
- Acknowledgments
- Summary
- 1. Introduction
- 2. Methodology
- 3. Results
- Studies Meeting Eligibility Criteria
- 1. Does HBOT improve mortality and morbidity in patients who have traumatic brain injury or nontraumatic brain injury, such as anoxic ischemic encephalopathy?
- 2. Does HBOT improve functional outcomes in patients who have cerebral palsy?
- 3. Does HBOT improve mortality and morbidity in patients who have suffered a stroke?
- 4. What are the adverse effects of using HBOT in brain injury, cerebral palsy or stroke patients?
- 4. Conclusions
- 1. Does HBOT improve mortality and morbidity in patients who have traumatic brain injury and anoxic ischemic encephalopathy?
- 2. Does HBOT improve functional outcomes in patients who have cerebral palsy?
- 3. Does HBOT improve mortality and morbidity in patients who have suffered a stroke?
- 4. What are the adverse effects of using HBOT in these conditions?
- 5. Future Research
- References
- Evidence Tables
- Bibliography
- Appendixes
- Appendix A. Indications for HBOT
- Appendix B. Research Team, Technical Expert Advisory Group, and Peer Reviewers
- Appendix C. Literature Search Strategies
- Appendix D. Quality Assessment Criteria
- Appendix E. Excluded Studies
- Appendix F. Studies with Intermediate Outcomes
- Appendix G. Unretrieved Studies
- Appendix H. Outcome measures used in HBOT studies
- Abbreviations and Acronyms
- Glossary of Terms
- Supplement. A Qualitative Assessment of Brain Injury, Cerebral Palsy and Stroke Patient, Caregiver and Clinician Values of Outcomes
- Supplement Appendix. Interview Guides
Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services.1 Contract No. 290-97-0018. Prepared by: Oregon Health & Science University Evidence-based Practice Center, Portland, Oregon.
Suggested citation:
McDonagh M, Carson S, Ash J, et al. Hyperbaric Oxygen Therapy for Brain Injury, Cerebral Palsy, and Stroke. Evidence Report/Technology Assessment No. 85 (Prepared by the Oregon Health & Science University Evidence-based Practice Center under Contract No 290-97-0018). AHRQ Publication No. 04-E050. Rockville, MD: Agency for Healthcare Research and Quality. September 2003.
This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.
AHRQ is the lead Federal agency charged with supporting research designed to improve the quality of health care, reduce its cost, address patient safety and medical errors, and broaden access to essential services. AHRQ sponsors and conducts research that provides evidence-based information on health care outcomes; quality; and cost, use, and access. The information helps health care decisionmakers—patients and clinicians, health system leaders, and policymakers—make more informed decisions and improve the quality of health care services.
The authors of this report are responsible for its content. Statements in the report should not be construed as endorsement by the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services of a particular drug, device, test, treatment, or other clinical service.
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540 Gaither Road, Rockville, MD 20850. www
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- Review Hyperbaric oxygen in the treatment of patients with cerebral stroke, brain trauma, and neurologic disease.[Adv Ther. 2005]Review Hyperbaric oxygen in the treatment of patients with cerebral stroke, brain trauma, and neurologic disease.Al-Waili NS, Butler GJ, Beale J, Abdullah MS, Hamilton RW, Lee BY, Lucus P, Allen MW, Petrillo RL, Carrey Z, et al. Adv Ther. 2005 Nov-Dec; 22(6):659-78.
- Hyperbaric oxygenation for cerebral palsy.[Lancet. 2001]Hyperbaric oxygenation for cerebral palsy.Neubauer RA. Lancet. 2001 Jun 23; 357(9273):2052; author reply 2053.
- Hyperbaric oxygen therapy for children with cerebral palsy.[S Afr Med J. 1998]Hyperbaric oxygen therapy for children with cerebral palsy.Venter A, Leary M, Schoeman J, Jacklin L, Rodda J, Adnams C, Lippert MM. S Afr Med J. 1998 Nov; 88(11):1362-3.
- Hyperbaric oxygen therapy for children with cerebral palsy.[S Afr Med J. 1999]Hyperbaric oxygen therapy for children with cerebral palsy.Cronje F. S Afr Med J. 1999 Apr; 89(4):359-60; author reply 361.
- Review Unestablished indications for hyperbaric oxygen therapy.[Diving Hyperb Med. 2014]Review Unestablished indications for hyperbaric oxygen therapy.Mitchell SJ, Bennett MH. Diving Hyperb Med. 2014 Dec; 44(4):228-34.
- Hyperbaric Oxygen Therapy for Brain Injury, Cerebral Palsy, and StrokeHyperbaric Oxygen Therapy for Brain Injury, Cerebral Palsy, and Stroke
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