No
evidence that hyperbaric oxygen improves neurological state or infarct size
following stroke.
Clinical Bottom Line:
1.No
evidence of improved neurological function in the oxygen-treated group at four
months.
2.No
evidence for reduced infarction size at four months.
Appraised
by: Mike Bennett
Dept of Diving and Hyperbaric
Medicine
Prince of Wales Hospital
Sydney; Monday, 15 February,
1999
Clinical
Scenario:
A 75 year old man with a cerebral ischaemic stroke presented for
treatment and we wondered if hyperbaric oxygen would improve outcome.
Three-part
Question: In patients presenting acutely
with ischaemic cerebral infarction, does the administration of hyperbaric oxygen
in addition to standard therapy, result in any improvement in functional ability
in the long-term?
Search
Terms: Brain infarction, central
nervous system diseases, stroke
The
Study:
Double-blinded concealed
randomised controlled trial with intention-to-treat.
Non-pregnant patients aged 20 to
90 years with onset of neurological deficit secondary to cerebral ischaemia in
the carotid artery territory on one side within the preceding two weeks. Minor
deficits excluded along with those rapidly resolving.
Control group (N =19;14 analysed):
Standard physical and occupational therapy in a neurological intensive care plus
sham hyperbaric oxygen exposures breathing air and at the times and pressures
outlined for the active group.
Patients received sedation as required and Vitamin E.
Experimental group (N =20;17
analysed): As above plus hyperbaric oxygen at 1.5ATA for 1 hour every 8 hours
for a total of 15 treatments.
Non-Event
Outcomes
Time to outcome
Air group HBO group
P-value
Mean
neurological
examination
scores
0(best)-100(worst)
4 months
25.6
34.5
0.33
Infarct
volumes
(mls)
4 months
29.0
49.2
0.25
Comments:
1. All trends were in the
direction of improvement in the air group.
2. The trial was stopped
prematurely (by an external monitoring committee) because of the above and poor
compliance.
3. There was also a trend to
larger infarct size on admission in the oxygen group which may explain the
findings.
4. The staff and patients found
compliance with the regime difficult.
5. Mean interval from stroke to
compression was 51.8 hours.
Expiry
date:
September
2004
References:
1. Anderson DC, Bottini AG,
Jagiella WM, Westphal B, Ford S, Rockswold GL, Loewenson RB. A pilot study of
hyperbaric oxygen in the treatment of human stroke. Stroke 1991; 22:1137-1142.
