October 30, 2014 Leave a comment
Hyperbaric Oxygen often referred to HBOT is a well-established and accepted intervention for many disorders ranging from gangrene to non-healing skin wounds and pressure ulcers for the bedridden. However, its potential applications are much greater than then presently accepted and FDA approved indications. Sadly, the FDA approval process is very expensive and few institutions could ever afford the process of applying and even if they did they would never recoup the cost of the research and legal expenses required to get the next indication approved for HBOT. The technology (hyperbaric chambers capable of the pressures required) are widely available in hospitals and HBOT centers. So anyone pushing the new indication through the FDA would be doing it for the benefit of all centers and that is an unlikely business model for success. Even more concerning is that third party payers use the FDA approval stamp as their threshold for reimbursement, so nearly all of the possible applications of HBOT to neurological disorders goes uncovered by insurers.
We will take a look at some of the data the FDA and insurers are blind to, but first a little about my background in hyperbaric medicine goes back to my days in the US Air Force where I was trained in Aerospace Medicine; including Hyperbarics. I worked at McDonnell Douglas (now Boeing) and participated in research regarding F15 and F18 pilot stress and ways to improve pilot g-force tolerance. And yes this really is me on the wing of an F18 at Naval Air Station Lemoore, California, where I received training from Marine pilots.
PLOS is a highly respected open-access scientific journal and this team headed by the Institute of Hyperbaric Medicine in Zefrin Israel, has put together some excellent data regarding the application of HBOT to late effects of neurological injuries (both stroke and post-traumatic head injuries). Lets look at the delayed benefits for stroke first.
These images indicate the area of the brain damaged by a stroke and the effect of HBOT at restoring blood flow to that region even very late after the stroke (images gathered in the study are from 6-36 months after a stroke). But restoring blood wouldn’t mean very much if it didn’t also restore function. Here is a quote from the abstract: “HBOT protocol: Two months of 40 sessions (5 days/week), 90 minutes each, 100% oxygen at 2 ATA. We found that the neurological functions and life quality of all patients in
both groups were significantly improved following the HBOT sessions while no improvement was found during the control period of the patients in the cross group. Results of SPECT imaging were well correlated with clinical improvement. Elevated brain activity was detected mostly in regions of live cells (as confirmed by CT) with low activity (based on SPECT) – regions of noticeable discrepancy between anatomy and physiology.”
So this is very strong data in favor of using this particular protocol for post stroke patients. For years I have advocated 2.2 ATA (about equal to 40 feet of water pressure) but at mere room air. One of the reasons I favor this protocol over the 100% O2 approach has to do with the blood vessel constriction that occurs with 100% O2. That tightening of blood flow is EXACTLY what we want in acute head injuries but it has always seemed less desirable in late effects. The 2.2 room air approach has also seemed very helpful and we are seeing recovery after severe (nearly fatal) head injury in the Hyperbaric PHP Center in Buford, GA. (More information is available at their website (http://www.hyperbaricphp.com/) and I suggest contacting Bill at the center if you have more questions.
Here is another publication from the Israeli team:
And here is the overall effect on cognition from their research.
The real question is this: given the terrible effects of head injury and stroke on the quality of life and productivity of the individuals suffering with these conditions, why don’t insurers pay for this therapy and why doesn’t FDA take the initiative to include these treatments in their approved applications of HBOT? When you figure that one out let me know, but my guess is it all comes down to money and more indications means more expense for the government and insurance companies. So for now, if you need this treatment it unfortunately be at your own expense. From all we know, that expense surely seems well justified.