The outbreak of coronavirus disease (COVID-19) has seen an international effort to understand, contain, treat and prevent the spreading of the virus. Laboratories from across the world have joined forces to develop effective treatment protocols for COVID-19 and a vaccine for immunity against the coronavirus.

There are multiple approaches to this global pandemic, starting with government and medical hospitals containment measures, to theoretical understanding of the virus and the disease, a pharmaceutical approach for developing a drug treatment, including technological and logistical approaches for treatment and life support for COVID-19 patients.

A number of tech companies have started developing supporting and monitoring equipment for oxygen therapy such as oxygen ventilators, pulse oximeters, oxygen concentrators, oxygen masks and various breathing aids, while Hyperbaric Medicine associations, HBOT equipment manufactures and medical HBOT facilities have started clinical testing for Hyperbaric Oxygen Therapy to be used as adjunctive treatment for COVID-19 and related pulmonary issues, like pneumonia and ARDS (Acute Respiratory Distress Symptom).

  • “Nowhere is the technology gap more apparent than in the provision of oxygen … Oxygen is seldom available in the poorest countries beyond urban hospitals and private providers. Pulse oximeters, effective and inexpensive diagnostic devices for measuring blood oxygen levels, are similarly unavailable to those who need them most.” 1
    • Henrietta H. Fore, Executive Director, UNICEF & Kevin Watkins, Chief Executive, Save the Children UK

A test for modern times

The race for combating the pandemic and its numerous life-threatening implications for mankind is a test for modern times. We live in an age where technology delivers a promise to improve the quality of living, and it has delivered that in all its applications, now the objective of technology is to prove it can save lives.

AHA Hyperbarics has been on the forefront of innovation in oxygen technology for over a decade, we develop patented oxygen concentrators and innovative high-pressure inflatable HBOT chambers that can reach 2 ATA (Atmospheres Absolute – two times sea level atmospheric pressure) for medical treatment protocols.

We support all international efforts to understand and treat COVID-19 related issues using hyperbaric oxygen therapy and have monitored a number of research developments regarding the use of HBOT in the battle against COVID-19.

There is good news out there for people that really need to hear good news.

A number of research papers have proved (with some caveats) that Hyperbaric Oxygen Therapy can favourably change the clinical course for at least some COVID-19 patients. We are seeing a global consensus to recognize that HBOT might prove vital for future COVID-19 treatments.

One of our most-trusted sources in regards to hyperbaric news is the European Committee for Hyperbaric Medicine (ECHM – www.echm.org), which have published an official position statement regarding primary guidelines for infection control, patient treatment and staff safety related with HBOT sessions during the coronavirus pandemic and the following years.

According to the document issued March 16th, it is highly recommended that every single medical hyperbaric facility should re-evaluate the risks of HBOT (related with the primary disease, comorbidities, possibilities of transportation, safety measures for conducting HBO sessions) for specific indications regarding patients with confirmed or suspected COVID-19 and take all necessary precautions.

Together with the safety guidelines from UHMS (Undersea & Hyperbaric Medical Society), the information is issued with the intended purpose to enhance infection prevention practices, address patient selection, and offer solutions for safe patient care practices for mono-place and multi-place hyperbaric facilities during the novel coronavirus disease (COVID-19) outbreak.

According to a more recent position statement issued April 30th, the ECHM and EUBS (European Underwater and Barometrical Society) bring confirmation there is possibility that HBOT  may have a beneficial effect in the treatment of certain patients with COVID-19, although the current level of anecdotal reporting does not allow for recommendations nor the issuing of guidelines with respect to the use of HBOT in the specific treatment of COVID-19.

The 3 organizations welcome and encourage clinical research projects and studies using HBOT as adjuvant therapy in COVID-19 and have issued the criteria to achieve clinically relevant conclusions.

  • The mode of action of HBOT could be due to mechanisms such as e.g. alleviating the oxygen debt caused by the ventilation/perfusion mismatch, reducing the inflammatory reactions and/or the effect of SARS-CoV2 on the oxygen-carrying capacities of hemoglobin, or other mechanisms which are still insufficiently documented in this setting and thus remain speculative in many aspects.
    • EUBS & ECHM position statement, April 30th

Clinical research projects and studies are currently being conducted worldwide for patients with respiratory distress.

One of the most debated studies, also featured by IHA (International Hyperbarics Association), is a Chinese report issued by Dr. Ruiyong Chen, Dr. Zhong Yangling and team from the Department of Hyperbaric Oxygen in Wuhan Yangtze River Shipping General Hospital, that successfully carried out HBOT treatment (at 1.4 ATA – 1.6 ATA) in 5 patients with COVID-19 (2 critical and 3 severe), which achieved significant results to help combat progressive hypoxemia (low blood oxygen levels) that COVID-19 can cause, which eventually leads to the increase in mortality rates.

Hyperbaric oxygen allows for greater levels of oxygen to pass through the thickened and inflamed lung tissue into the blood stream, thereby directly treating the hypoxemia.

According to the evaluation of the effectiveness of HBOT in oxygen therapy for critical patients with COVID-19, the demonstration report has issued such results as – rapid relief of hypoxic symptoms, rapid correction of hypoxemia, general condition reversal, improved lung pathology, overcoming lung tissue inflammation, improving tissue cell oxygen uptake and many more.

One important caveat made by the study is that HBOT is not the etiological treatment of COVID-19, it is the symptomatic treatment of hypoxia in patients with COVID-19, and it is a supplement to the existing oxygen treatment technology.

In conclusion, according to Dr. Paul G HarchPreliminary evidence from China strongly suggests that based on the immutable science of HBOT and recent clinical application to deteriorating severely hypoxemic COVID-19 pneumonia patients HBOT has significant potential to impact the COVID-19 pandemic.”

The UHMS (Undersea & Hyperbaric Medical Society) is the primary source of scientific information for diving and hyperbaric medicine physiology worldwide. They have also issued a position statement about Chinese studies, including a rationale for the effectiveness of HBO for COVID-19.

Harch PG. Hyperbaric oxygen treatment of novel coronavirus (COVID-19) respiratory failure. Med Gas Res [Epub ahead of print] [cited 2020 May 7]. Available from: http://www.medgasres.com/preprintarticle.asp?id=282177

The UHMS is currently following the development of several clinical studies, some conducted by NYU, Ochsner Health System and Karolinska Institute. Results for these studies are projected for the end of June 2020 to November 2021.

NYU Winthrop Hospital clinical studies are conducted to examine whether HBOT may help reduce the infection reaction to COVID-19 in order to help with the recovery process and decrease the need for mechanical ventilation. In summary, HBOT treatment (2 ATA, 90 minutes) will be provided to patients as an adjunct to standard therapy for a cohort of 40 COVID-19 positive patients with respiratory distress at NYU Winthrop Hospital. 

Ochsner Health System clinical trials are conducted for the evaluation of the overall hypothesis that HBO may reduce mortality, increase hypoxia tolerance and prevent organ failure in patients with COVID19 pneumonitis by attenuating the inflammatory response.

The Karolinska Institutet clinical trials follow the main objective to evaluate if HBO (1.6-2.4 ATA) reduces the number of ICU admissions compared to best practice for COVID-19, including secondary objectives to evaluate if HBO reduces mortality in severe cases of COVID-19, reduces morbidity associated with COVID-19, reduces the load on ICU resources in COVID-19 and to mitigate the inflammatory reaction /ș9in COVID-19, as well as to evaluate if HBO is safe for SARS-CoV-2 positive patients and staff.  The clinical studies are developed for a population of 200 adult patients with SARS-CoV-2 infection, with at least two risk factor for increased mortality, likely to develop ARDS criteria and need intubation within 7 days of admission to hospital. 

One additional ray of hope comes from Dr. Catherine Fife, hyperbaric medicine physician. Dr. Catherine Fife keeps an updated journal from the frontlines of the pandemic and writes that – “It has become apparent that COVID-19 pneumonia does NOT behave like garden-variety Adult Respiratory Distress Syndrome (ARDS) and that intubation should be avoided if possible. But how to handle the profound hypoxia of COVID-19 when 100% oxygen is not enough? Anyone who understands the physiology of diving or hyperbaric medicine will tell you the answer is simple – raise the partial pressure of oxygen higher than you can breathe 100% oxygen at ground level. To do that, you have to raise the atmospheric pressure – and the way to do that is with hyperbaric oxygen therapy (HBOT). Initially, a handful of patients were treated in China. Not only did their arterial oxygen levels improve, but in some cases, patients stabilized and their lung damage seemed to improve. Cautiously, at various places across the USA, doctors have begun using HBOT in hopes of avoiding intubation for COVID-19 pneumonia.”

According to Dr. Kerry Thibodeaux at Opelousas General Hospital in Los Angeles, USA – “Simply stated, hyperbaric treatments could be an effective way to treat COVID-19 patients suffering from severe respiratory distress. When weighing the risks to the patient and the potential for intubation, hyperbaric oxygen therapy was determined to be a far better option for those meeting criteria”.

A study from AAMHEI (The Argentine Association of Hyperbaric Medicine and Research) has concluded that: “HBOT could cooperate in the treatment and support of the COVID-19 infected patient, through its strong anti-inflammatory activity, modulation of the immune system and potential antiviral action, all typical of the hyperoxia generated with HBOT treatment.” 

The medical team from Golestan Hospital in Tehran, Iran, lead by Sasan Soltanzad have started HBOT trials on patients with COVID-19 using 2 ATA pressures (10 min descending, 60 min continuous oxygen with mask, 10 min ascending with oxygen), monitoring progress and oxygen saturation levels. The case report will be issued after the research is conducted.

Dr. Joe Dituri, director of the Undersea Oxygen Clinic in Tampa, believes that early treatment in patients with COVID-19 symptoms could prevent more people from reaching critical stages of the disease (prior to the point where people need respirators) and overwhelming already-exhausted medical resources.

  • “The progress of COVID-19 is a systemic inflammatory response. It chokes lung cells, then the body lacks oxygen and blood vessels dilate. “The body cues an immune-response ‘red alert’ that makes you insane with inflammation and that can crash your blood pressure. Hyperbarics reduces inflammation, boosts immunity and helps produce more STEM cells to fix what’s broken.”
    • Dr. Joe Dituri

Breathe the future

There are multiple voices advocating for the use of adjunctive HBOT in the fight against COVID-19, yet there is still a long way to go before clinical research meets all necessary evaluation and peer-review, however preliminary results are optimistic.

We at AHA Hyperbarics have been supporters of HBOT for decades and have monitored all research developments regarding the technology and the medical treatment. In our experience, there is one hopeful perspective to this crisis, we are witnessing a speedy increase in innovation when multiple laboratories and research facilities work together for the safety and health of patients.

We are confident that HBOT can and will prove beneficial in the treatment for COVID-19 and related health issues, including in the recovery period, due to extensive studies that already certify the systemic benefits of the therapy, physical and mental. We know for sure that hyperbaric oxygen therapy can strengthen the immune system to guard us against various health problems.

A race for oxygen has just begun, we are very glad there’s an international consensus to pick up the pace with research and validation.

 

 

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