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

View More View Less
  • 1 Division of Neurosurgery and Department of Neurology, Hennepin County Medical Center; Department of Neurosurgery, University of Minnesota; and Department of Planning and Development, Hennepin County Administration, Minneapolis, Minnesota
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

✓ 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.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Address reprint requests to: Gaylan L. Rockswold, M.D., Division of Neurosurgery, Hennepin County Medical Center, 701 Park Avenue South, Minneapolis, Minnesota 55415.
  • 1.

    Anderson DC, , Bundlie S, & Rockswold GL: Multimodality evoked potentials in closed head trauma. Arch Neurol 41:369374, 1984 Anderson DC, Bundlie S, Rockswold GL: Multimodality evoked potentials in closed head trauma. Arch Neurol 41:369–374, 1984

    • Search Google Scholar
    • Export Citation
  • 2.

    Anderson DW, , Miller JD, & Kalsbeek WD: Findings from a major U.S. survey of persons hospitalized with head injuries. Public Health Rep 98:475478, 1983 Anderson DW, Miller JD, Kalsbeek WD: Findings from a major U.S. survey of persons hospitalized with head injuries. Public Health Rep 98:475–478, 1983

    • Search Google Scholar
    • Export Citation
  • 3.

    Bergman TA, , Rockswold GL, & Haines SJ, et al: Outcome of severe closed head injury in the Midwest. A review and comparison with other major head trauma studies. Minn Med 70:397401, 1987 Bergman TA, Rockswold GL, Haines SJ, et al: Outcome of severe closed head injury in the Midwest. A review and comparison with other major head trauma studies. Minn Med 70:397–401, 1987

    • Search Google Scholar
    • Export Citation
  • 4.

    Clark JM, & Fisher AB: Oxygen toxicity and extension of tolerance in oxygen therapy, in Davis JC, & Hunt TK (eds): Hyperbaric Oxygen Therapy. Bethesda, Md: Undersea Medical Society, 1977, pp 6177 Clark JM, Fisher AB: Oxygen toxicity and extension of tolerance in oxygen therapy, in Davis JC, Hunt TK (eds): Hyperbaric Oxygen Therapy. Bethesda, Md: Undersea Medical Society, 1977, pp 61–77

    • Search Google Scholar
    • Export Citation
  • 5.

    Contreras FL, , Kadekaro M, & Eisenberg HM: The effect of hyperbaric oxygen on glucose utilization in a freeze-traumatized rat brain. J Neurosurg 68:137141, 1988 Contreras FL, Kadekaro M, Eisenberg HM: The effect of hyperbaric oxygen on glucose utilization in a freeze-traumatized rat brain. J Neurosurg 68:137–141, 1988

    • Search Google Scholar
    • Export Citation
  • 6.

    Gamache FW: Evaluation of nervous system trauma: an overview. Infect Surg 3:485488, 1984 Gamache FW: Evaluation of nervous system trauma: an overview. Infect Surg 3:485–488, 1984

    • Search Google Scholar
    • Export Citation
  • 7.

    Hall ED, , Yonkers PA, & McCall JM, et al: Effects of the 21-aminosteroid U74006F on experimental head injury in mice. J Neurosurg 68:456461, 1988 Hall ED, Yonkers PA, McCall JM, et al: Effects of the 21-aminosteroid U74006F on experimental head injury in mice. J Neurosurg 68:456–461, 1988

    • Search Google Scholar
    • Export Citation
  • 8.

    Harper AM, & Glass HI: Effect of alterations in the arterial carbon dioxide tension on the blood flow through the cerebral cortex at normal and low arterial blood pressures. J Neurol Neurosurg Psychiatry 28:449452, 1965 Harper AM, Glass HI: Effect of alterations in the arterial carbon dioxide tension on the blood flow through the cerebral cortex at normal and low arterial blood pressures. J Neurol Neurosurg Psychiatry 28:449–452, 1965

    • Search Google Scholar
    • Export Citation
  • 9.

    Hayakawa T, , Kanai N, & Kuroda R, et al: Response of cerebrospinal fluid pressure to hyperbaric oxygenation. J Neurol Neurosurg Psychiatry 34:580586, 1971 Hayakawa T, Kanai N, Kuroda R, et al: Response of cerebrospinal fluid pressure to hyperbaric oxygenation. J Neurol Neurosurg Psychiatry 34:580–586, 1971

    • Search Google Scholar
    • Export Citation
  • 10.

    Holbach KH, , Caroli A, & Wassmann H: Cerebral energy metabolism in patients with brain lesions of normo- and hyperbaric oxygen pressures. J Neurol 217:1730, 1977 Holbach KH, Caroli A, Wassmann H: Cerebral energy metabolism in patients with brain lesions of normo- and hyperbaric oxygen pressures. J Neurol 217:17–30, 1977

    • Search Google Scholar
    • Export Citation
  • 11.

    Holbach KH, , Wassmann H, & Kolberg T: Verbesserte Reversibilität des traumatischen Mittelhirnsyndroms bei Anwendung der hyperbaren Oxygenierung. Acta Neurochir 30:247256, 1974 Holbach KH, Wassmann H, Kolberg T: Verbesserte Reversibilität des traumatischen Mittelhirnsyndroms bei Anwendung der hyperbaren Oxygenierung. Acta Neurochir 30:247–256, 1974

    • Search Google Scholar
    • Export Citation
  • 12.

    Ikeda Y, & Long DM: The molecular basis of brain injury and brain edema: the role of oxygen free radicals. Neurosurgery 27:111, 1990 Ikeda Y, Long DM: The molecular basis of brain injury and brain edema: the role of oxygen free radicals. Neurosurgery 27:1–11, 1990

    • Search Google Scholar
    • Export Citation
  • 13.

    Jacobson I, , Harper AM, & McDowall DG: The effects of oxygen at 1 and 2 atmospheres on the blood flow and oxygen uptake of the cerebral cortex. Surg Gynecol Obstet 119:737742, 1964 Jacobson I, Harper AM, McDowall DG: The effects of oxygen at 1 and 2 atmospheres on the blood flow and oxygen uptake of the cerebral cortex. Surg Gynecol Obstet 119:737–742, 1964

    • Search Google Scholar
    • Export Citation
  • 14.

    Jacobson I, , Harper AM, & McDowall DG: The effects of oxygen under pressure on cerebral blood-flow and cerebral venous oxygen tension. Lancet 2:549, 1963 Jacobson I, Harper AM, McDowall DG: The effects of oxygen under pressure on cerebral blood-flow and cerebral venous oxygen tension. Lancet 2:549, 1963

    • Search Google Scholar
    • Export Citation
  • 15.

    Jennett B, , Snoek J, & Bond MR, et al: Disability after severe head injury: observations on the use of the Glasgow Outcome Scale. J Neurol Neurosurg Psychiatry 44:285293, 1981 Jennett B, Snoek J, Bond MR, et al: Disability after severe head injury: observations on the use of the Glasgow Outcome Scale. J Neurol Neurosurg Psychiatry 44:285–293, 1981

    • Search Google Scholar
    • Export Citation
  • 16.

    Kanai N, , Hayakawa T, & Mogami H: Blood flow changes in carotid and vertebral arteries by hyperbaric oxygenation. Neurology 23:159163, 1973 Kanai N, Hayakawa T, Mogami H: Blood flow changes in carotid and vertebral arteries by hyperbaric oxygenation. Neurology 23:159–163, 1973

    • Search Google Scholar
    • Export Citation
  • 17.

    Kety SS, & Schmidt CF: The effects of altered arterial tensions of carbon dioxide and oxygen on cerebral blood flow and cerebral oxygen consumption of normal young men. J Clin Invest 27:484492, 1948 Kety SS, Schmidt CF: The effects of altered arterial tensions of carbon dioxide and oxygen on cerebral blood flow and cerebral oxygen consumption of normal young men. J Clin Invest 27:484–492, 1948

    • Search Google Scholar
    • Export Citation
  • 18.

    Lambertsen CJ, , Kough RH, & Cooper DY, et al: Oxygen toxicity. Effects in man of oxygen inhalation at 1 and 3.5 atmospheres upon blood gas transport, cerebral circulation and cerebral metabolism. J Appl Physiol 5:471486, 1953 Lambertsen CJ, Kough RH, Cooper DY, et al: Oxygen toxicity. Effects in man of oxygen inhalation at 1 and 3.5 atmospheres upon blood gas transport, cerebral circulation and cerebral metabolism. J Appl Physiol 5:471–486, 1953

    • Search Google Scholar
    • Export Citation
  • 19.

    Miller JD: The effects of hyperbaric oxygen at 2 and 3 atmospheres absolute and intravenous mannitol on experimentally increased intracranial pressure. Eur Neurol 10:111, 1973 Miller JD: The effects of hyperbaric oxygen at 2 and 3 atmospheres absolute and intravenous mannitol on experimentally increased intracranial pressure. Eur Neurol 10:1–11, 1973

    • Search Google Scholar
    • Export Citation
  • 20.

    Miller JD, , Fitch W, & Ledingham IM, et al: The effect of hyperbaric oxygen on experimentally increased intracranial pressure. J Neurosurg 33:287296, 1970 Miller JD, Fitch W, Ledingham IM, et al: The effect of hyperbaric oxygen on experimentally increased intracranial pressure. J Neurosurg 33:287–296, 1970

    • Search Google Scholar
    • Export Citation
  • 21.

    Miller JD, & Ledingham IM: Reduction of increased intracranial pressure. Comparison between hyperbaric oxygen and hyperventilation. Arch Neurol 24:210216, 1971 Miller JD, Ledingham IM: Reduction of increased intracranial pressure. Comparison between hyperbaric oxygen and hyperventilation. Arch Neurol 24:210–216, 1971

    • Search Google Scholar
    • Export Citation
  • 22.

    Muizelaar JP: Cerebral blood flow, cerebral blood volume, and cerebral metabolism after severe head injury, in Becker DP, & Gudeman SK (eds): Textbook of Head Injury. Philadelphia: WB Saunders, 1989, pp 221240 Muizelaar JP: Cerebral blood flow, cerebral blood volume, and cerebral metabolism after severe head injury, in Becker DP, Gudeman SK (eds): Textbook of Head Injury. Philadelphia: WB Saunders, 1989, pp 221–240

    • Search Google Scholar
    • Export Citation
  • 23.

    Nagao S, , Okumura S, & Nishimoto A: Effects of hyperbaric oxygenation on cerebral vasomotor tone in acute intracranial hypertension: an experimental study. Resuscitation 4:5159, 1975 Nagao S, Okumura S, Nishimoto A: Effects of hyperbaric oxygenation on cerebral vasomotor tone in acute intracranial hypertension: an experimental study. Resuscitation 4:51–59, 1975

    • Search Google Scholar
    • Export Citation
  • 24.

    National Institute of Neurological Disorders and Stroke: Head Injury: Hope through Research. Bethesda, Md: National Institutes of Health, 1984, NIH Publication No 84-2478 National Institute of Neurological Disorders and Stroke: Head Injury: Hope through Research. Bethesda, Md: National Institutes of Health, 1984, NIH Publication No 84-2478

    • Search Google Scholar
    • Export Citation
  • 25.

    Reivich M, , Holling HE, & Roberts B, et al: Reversal of blood flow through the vertebral artery and its effect on cerebral circulation. N Engl J Med 265:878885, 1961 Reivich M, Holling HE, Roberts B, et al: Reversal of blood flow through the vertebral artery and its effect on cerebral circulation. N Engl J Med 265:878–885, 1961

    • Search Google Scholar
    • Export Citation
  • 26.

    Robertson CS, , Narayan RK, & Gokaslan ZL, et al: Cerebral arteriovenous oxygen difference as an estimate of cerebral blood flow in comatose patients. Neurosurg 70:222230, 1989 Robertson CS, Narayan RK, Gokaslan ZL, et al: Cerebral arteriovenous oxygen difference as an estimate of cerebral blood flow in comatose patients. Neurosurg 70:222–230, 1989

    • Search Google Scholar
    • Export Citation
  • 27.

    Rockswold GL, , Ford SE, & Anderson BJR, et al: Patient monitoring in the monoplace hyperbaric chamber. Hyperbaric Oxygen Rev 6:161168, 1985 Rockswold GL, Ford SE, Anderson BJR, et al: Patient monitoring in the monoplace hyperbaric chamber. Hyperbaric Oxygen Rev 6:161–168, 1985

    • Search Google Scholar
    • Export Citation
  • 28.

    Siesjo BK, , Agardh CD, & Bengtsson F: Free radicals and brain damage. Cerebrovasc Brain Metab Rev 1:165211, 1989 Siesjo BK, Agardh CD, Bengtsson F: Free radicals and brain damage. Cerebrovasc Brain Metab Rev 1:165–211, 1989

    • Search Google Scholar
    • Export Citation
  • 29.

    Sosin DM, , Sacks JJ, & Smith SM: Head injury — associated deaths in the United States from 1979 to 1986. JAMA 262:22512255, 1989 Sosin DM, Sacks JJ, Smith SM: Head injury — associated deaths in the United States from 1979 to 1986. JAMA 262:2251–2255, 1989

    • Search Google Scholar
    • Export Citation
  • 30.

    Sukoff MH, & Ragatz RE: Hyperbaric oxygenation for the treatment of acute cerebral edema. Neurosurgery 10:2938, 1982 Sukoff MH, Ragatz RE: Hyperbaric oxygenation for the treatment of acute cerebral edema. Neurosurgery 10:29–38, 1982

    • Search Google Scholar
    • Export Citation
  • 31.

    Teasdale G, & Jennett B: Assessment of coma and impaired consciousness. A practical scale. Lancet 2:8183, 1974 Teasdale G, Jennett B: Assessment of coma and impaired consciousness. A practical scale. Lancet 2:81–83, 1974

    • Search Google Scholar
    • Export Citation
  • 32.

    Vatassery GT, , Angerhofer CK, & Knox CA, et al: Concentrations of vitamin E in various neuroanatomical regions and subcellular fractions, and the uptake of vitamin E by specific areas, of rat brain. Biochim Biophys Acta 792:118122, 1984 Vatassery GT, Angerhofer CK, Knox CA, et al: Concentrations of vitamin E in various neuroanatomical regions and subcellular fractions, and the uptake of vitamin E by specific areas, of rat brain. Biochim Biophys Acta 792:118–122, 1984

    • Search Google Scholar
    • Export Citation
  • 33.

    Vatassery GT, , Angerhofer CK, & Peterson FJ: Vitamin E concentrations in the brains and some selected peripheral tissues of selenium-deficient and vitamin E-deficient mice. J Neurochem 42:554558, 1984 Vatassery GT, Angerhofer CK, Peterson FJ: Vitamin E concentrations in the brains and some selected peripheral tissues of selenium-deficient and vitamin E-deficient mice. J Neurochem 42:554–558, 1984

    • Search Google Scholar
    • Export Citation
  • 34.

    Vatassery GT, , Brin MF, & Fahn S, et al: Effect of high doses of dietary vitamin E on the concentrations of vitamin E in several brain regions, plasma, liver, and adipose tissue of rats. J Neurochem 51:621623, 1988 Vatassery GT, Brin MF, Fahn S, et al: Effect of high doses of dietary vitamin E on the concentrations of vitamin E in several brain regions, plasma, liver, and adipose tissue of rats. J Neurochem 51:621–623, 1988

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 654 222 11
Full Text Views 247 14 0
PDF Downloads 149 10 1
EPUB Downloads 0 0 0