Hyperbaric
oxygen following ischaemic stroke significantly improved some disability scores
one year after treatment.
Clinical Bottom Line:
1.
There was an indication of better disability and neurological dysfunction
scores one year following stroke when hyperbaric oxygen was administered.
2.
However, there was not significantly greater improvement in comparing the
pre-treatment and post-treatment scores when hyperbaric oxygen was given. The
benefit remains unclear.
Appraised
by: Mike Bennett, Dept of Diving and
Hyperbaric Medicine, Prince of Wales Hospital, Sydney; Thursday, 1 April 1999
Clinical
Scenario: A patient with an ischaemic
stroke presented acutely for treatment. We wondered if the administration of
hyperbaric oxygen would improve outcome.
Three-part
Question: For patients with an acute
ischaemic stroke, does the addition of hyperbaric oxygen to the normal regimen
of care, result in any improvement in functional outcome or speed of recovery?
Search
Terms: Stroke
The
Study:
Double-blinded randomised
controlled trial without intention-to-treat.
Neurological deficit, confirmed
on CT scan, due to ischaemic stroke in the middle cerebral arterial territory
within the previous 24 hours.
Control group (N =17;13 analysed):
Standard therapy including low-dose heparin, nursing and rehab/speech therapy
etc. Sham hyperbaric oxygen treatment on air at 1.2 ATA 40 minutes daily for ten
days.
Experimental group (N =17;14
analysed): As above with hyperbaric oxygen therapy for ten days at 1.5ATA for 40
minutes.
The
Evidence:
Non-Event
Outcomes
Time to outcome
Air group
HBO group P-value
Orgonzo
neuro deficit
scale
(0-100)
1 year
50.3
78.2
0.02
Change
in Orgonzo
pre-post
treatment
1 year
19.1
35.9
0.16
Trouillas
disability scale
(0-10)
1
year
6.3
4.1
0.03
Rankin
disability scale
1 year
3.0
2.4
0.11
Comments:
1. Four patients lost from sham
and three from active group for a variety of reasons. Three deaths in the sham
group, none in active group.
2. Nature and validity of these
scales not discussed here.
3. A relatively small study
which did not have sufficient power to prove significant benefit.
Expiry date: September 2004
References: 1. Nighoghossian N, Trouillas M, Adeleine P, Salord F. Hyperbaric oxygen in the treatment of acute ischaemic stroke. A double-blind pilot study. Stroke 1995; 26:1369-1372
