Hyperbaric Treatment post Cardiac Arrest

[Superlite37]

Has anyone heard of or seen this done? I see that there has been some research done on this, LSU in particular, but I think their testing has mostly been animal based.

I have some experience with this while working offshore, getting ROSC back with extended and or unknown down times with divers. However, Chamber treatments are a given for a Diver in arrest, and with most Diver arrests, its unknown if the arrest was caused by a barotrauma or some other cause. Therefore its not the best example

Also, slightly different note, does anyone actually use Hypodermic treatment for the same? We have protocols for it, but don't have a receiving facility that continues it. Many thanks!

 

[chaz90]

I don't know much about hyperbaric chambers use for cardiac arrest patients. Admittedly, I'm not overly familiar with treating dive injuries or barotrauma either.

As far as your second question, I'll assume you mean hypothermia rather than hypodermic. Yes, we do use therapeutic hypothermia on patients with ROSC. I haven't seen it used since I've been in my new system, but I believe all three county hospitals will continue cooling our patients.

 

[Clipper1]

In the LSU study, I think all but one pig or whatever animal they were using, died.

For diving:

http://dornsife.usc.edu/hyperbaric/home/index.cfm

The hospitals which do have HBO chambers will more than likely have monoplace and not the big multiplace chambers.

There are more protocols to bring a patient out of a chamber if they have a cardiac arrest than there are to keep them down.

Having a qualified team readily available for a full press resuscitation in a chamber would be challenging. Training several hundred Paramedics to dive with the patient would be even more challenging and risky.

HBO had been used to some extent for many different ischemic brain injuries for many years.

Hypothermic therapy?
Try the Resuscitation journal.
http://www.resuscitationjournal.com/

A review of the studies showed non-significant results for prehospital hypothermia. It is very expensive and with mixed results. Early and effective CPR is usually the defining key. without it you can chill to the ice age and nothing will bring back the neuro function.

 

[Superlite37]

chaz90,
Thanks, I just wondered how many services actually use therapeutic hypothermia, not just have it in protocols.

Clipper1,
I know the logistics of trying to press down a Code and team would be crazy. After reading my post, I think I didn't make my entire question clear. Besides using hyperbaric treatment as part of a code treatment, is it being used therapeutically after ROSC? Sorry for the incomplete question.

 

[Clipper1]

It a chamber is available, of course it could be used but probably for more specific known etiologies like an air embolism from a catheter or some surgical procedure. The other part of a cardiac arrest from a "cardiac" situation would be prioritizing cath lab, hypothermia and determining if the patient might still benefit from HBO provided the patient is stable and a chamber is nearby.

It is used for some brain injuries and I do know we (Children's Hospital with access to HBO) have had some decent outcomes in the Pediatric population in this area. Adults may have varying results due to other disease processes that come with aging which are then affected by the cardiac arrest. But then again, there have been some decent results even in CVAs for adults post event.

You might start your research here for more specific info.
http://membership.uhms.org/

 

[ThadeusJ]

Both monoplace and multiplace chambers are saturated with oxygen. Would there not be a high probability that the patient would be on a monitor and perhaps pads that could result in a spark? The staff I know who "dive" in multiplace chambers must wear special suits and shoes that eliminate the possibility of static electricity based sparks.

As Clipper1 mentions, most sites are monoplace, severely restricting your patient access. One final point, isn't the goal of hyperbaric therapy to increase PO2 up to 2000 mmHg? Does this not contradict all the research that recommends restricting oxygen delivery post arrest?

 

[DiverMedic]

HBO Therapy

I did a seminar with Van Meter out of West Jefferson Hospital in New Orleans. Supposedly he has had a couple of successful trials with animals.

They also have a nice multi-place chamber and often give tours upon request.

 

[jwk]

Both monoplace and multiplace chambers are saturated with oxygen. Would there not be a high probability that the patient would be on a monitor and perhaps pads that could result in a spark? The staff I know who "dive" in multiplace chambers must wear special suits and shoes that eliminate the possibility of static electricity based sparks.

As Clipper1 mentions, most sites are monoplace, severely restricting your patient access. One final point, isn't the goal of hyperbaric therapy to increase PO2 up to 2000 mmHg? Does this not contradict all the research that recommends restricting oxygen delivery post arrest?

Special suits? They're called scrubs.

 

[ThadeusJ]

You can't wear normal scrubs as they can generate static electricity. Today you can buy hyperbaric scrubs, but when I started in respiratory they wore jumpsuits (gold, no less) that looked like something off Star Trek. If you ever take off scrubs in a dark room (like headin to bed after a shift), you can see the static charges being created if the conditions are right. You don't want to do that in 100% oxygen environment.

 

[Clipper1]

The scrubs just need to be 100% cotton. They come in different colors and are found in most uniform stores.

Monoplace chamber facilities usually are not that concerned about the scrubs.

 

[jwk]

The scrubs just need to be 100% cotton. They come in different colors and are found in most uniform stores.

Monoplace chamber facilities usually are not that concerned about the scrubs.

100% cotton is the key - which all our scrubs are. Most "real" hospital scrubs are as well, an old throwback to the flammable anesthetic days.

 

[PotatoMedic]

To note not all chambers are pressurized with 02. The one in Seattle uses air to pressurize the chamber. and they have special masks or hoods for the 100% 02. So you could use it purely at room air.

 

[Summit]

To note not all chambers are pressurized with 02. The one in Seattle uses air to pressurize the chamber. and they have special masks or hoods for the 100% 02. So you could use it purely at room air.

It isn't the mix so much as the partial pressures. You can pressurize room air and it increases the fire hazard and lowers flash points by upping the ppO2. 20.9% O2 at 4.78atm is the same as 100% at 1atm.

 

[PotatoMedic]

Ínteresting.... never thought of it that way. Time to do some studying.