For months, the coronavirus pandemic has continued its worldwide spread, but the development of effective treatments is still lacking. Given the likelihood of second and third waves to the coronavirus pandemic, similar to the Spanish Flu experience, the need for effective treatment is still emergent. While we have seen a number of different drugs progress through the treatment/study (and news) cycle, their effectiveness remains an open question. This lack of consensus agreement on the best treatment course is why in early March I called for more resources to be put toward studying the impact of Hyperbaric Oxygen Therapy (HBOT) in treating COVID-19 patients, especially those who seemed destined to need ventilator care.
Published and unpublished evidence is accumulating on improvement in coronavirus patients treated with HBOT. Doctors in China officially published their 5-patient case-series experience in a Chinese language journal and physicians in Louisiana presented their experience with 5 patients in a webinar, both last week. Additional positive experience will be announced in the coming days. The results in China and Louisiana are very similar and mimic the experience of Dr. Orval Cunningham with dying Spanish Flu patients in 1918. Formal studies on HBOT in coronavirus are underway at a number of sites internationally and in the U.S. with additional studies to begin soon.
In the meantime, however, there is nothing to prevent physicians from treating coronavirus patients off-label with HBOT and informed consent in identical fashion to the treatment with hydroxychloroquine and other off-label drugs.
This is known as the practice of medicine and occurs in doctors’ offices and hospitals every day throughout the U.S. When compared to the trial and error method already being conducted with these drugs, the risk profile appears to be less with HBOT and there is a solid scientific argument for HBOT posted here and in Medical Gas Research along with successful precedence in a near-identical viral pulmonary infection, the Spanish Flu Pandemic of 1918.
Doctors in China who used HBOT noted no complications in their 35 HBOT coronavirus patients and there is no report of complications from the Louisiana patients. In addition, equally or more severely ill patients with severe blunt chest trauma and the equivalent acute respiratory distress syndrome (ARDS) seen in dying coronavirus patients were successfully treated with HBOT in Russia in 2003 with 100% survival and no mention of complications. The Chinese, Louisiana, and Russian experience all used oxygen pressures in the 1.6-2.0 ATA range for different times while Dr. Cunningham used 1.68 ATA of air. In consideration of all of the data and experience which includes the effects on anti-inflammatory gene activation at 1.5 ATA , 1.6 ATA maybe the most effective dose.
While I encourage the off-label application of HBOT to coronavirus patients (i.e., treatment of coronavirus patients with HBOT) I have posted below our final Louisiana State University IRB (Institutional Review Board)-reviewed protocol and consent to facilitate, expedite, and assist physicians and researchers at any hospital with their IRB application for an HBOT coronavirus study. Any “study” and treatment experience contributes helpful information, but the medical profession will likely not be moved to action without randomized controlled designs. Hopefully, more studies will be conducted in hospital settings so that we can further determine the effectiveness of this treatment in a safe and controlled environment.
I would caution against using hyperbaric pressures over 2.0 ATA because of the distinct possibility of increasing the lung injury. In fact, short (one hour) times and pressures close to 1.6 ATA may afford the best opportunity of modulating the lung injury in coronavirus, tiding the patient over the most critical phase of the illness, preventing intubation, and hastening discharge from the hospital.
Read the full article source with the IRB application and consent enclosed!