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Undersea and Hyperbaric Medicine Section Newsletter - January 2008, Vol 15, #1

Undersea and Hyperbaric Medicine

circle_arrow Message from the Chair
circle_arrow Undersea and Hyperbaric Medicine: A True Sub-specialty of Emergency Medicine
circle_arrow LSU School Of Medicine, New Orleans
Hyperbaric Medicine Fellowship
circle_arrow Journal Watch


Newsletter Index


Hyperbaric Medicine Section

 

 

 

Message from the Chair

Christopher J. Logue, MD

We had a great turn-out at the Hyperbaric Section meeting at Scientific Assembly in Seattle this past October. Dave Dinsmore (Director of the NOAA Diving Center) gave a presentation about the NOAA Diving Program and the Aquarius Underwater Habitat. In addition, Neil Hampson (Director of the Center for Hyperbaric Medicine at Virginia Mason Medical Center) stopped by to discuss information sharing and a stronger collaboration with the Undersea and Hyperbaric Medicine Society.

After the meeting, a tour of the new multi-place chamber at Virginia Mason was conducted by Dr. Hampson. Later that day, several of our members went to see the impressive facilities at the NOAA Diving Center in Seattle and a tour was provided by Dave Dinsmore. On behalf of the section, we thank Dave and Neil for taking time out of their schedules to meet with us.

The section meeting was a busy one and I find it an exciting time to serve as chair. As we proceed with a full agenda, I want to remind everyone about the three main objectives of the section:

  1. To provide a forum for the exchange of information and ideas between emergency medicine physicians who practice and are interested in Undersea and Hyperbaric Medicine.
  2. To promote research and education in the field of Undersea and Hyperbaric Medicine.
  3. To provide a voice for the members of the section to be heard by the leaders and Board of ACEP.

The first goal can be achieved through numerous avenues. One is by using the section e-mail list-serve to ask questions and initiate a discussion or exchange of ideas. hyperbaric.section@elist.acep.org

Members can also contact Margaret Montgomery, RN (Staff Liaison), David C. Seaberg, MD, FACEP (Board Liaison) or me (cjologue@yahoo.com ) with any questions or comments.

This year, with the help of our superb co-editors (Marvin Heyboer III, MD, FACEP and David Lambert, MD), we will be publishing a quarterly newsletter. We encourage members to participate actively in this publication and welcome correspondence and articles from different members that will improve the quality and scope of the newsletter. In addition, constructive criticism from members is important and will help us improve the newsletter as time passes.

We have decided to add a section to the newsletter called "Spotlight" that will feature a particular hyperbaric medicine fellowship affiliated with an academic emergency medicine program in order to help achieve our second objective. This month we highlight the program at Louisiana State University (LSU).

A lot of progress has been made over the past year in our efforts to promote research and education in the field of Undersea and Hyperbaric Medicine. I am pleased to announce that there are now five ACGME accredited fellowships listed under the primary specialty of emergency medicine. I refer you to the editorial in this issue for more information and an updated list of the programs with contact information.

For those of you who have been in practice for many years, have not had the opportunity to participate in fellowship training, and are not yet board certified in Undersea and Hyperbaric Medicine - all is not lost. ABEM has kept open the practice-plus pathway tract and the non-accredited fellowship training tract until 2010. We encourage you to complete the requirements for these tracts and obtain your board certification. Below is a link to ABEM with information about these alternative pathways to board certification: http://www.abem.org/public/portal/alias__Rainbow/lang__en-US/tabID__3408/DesktopDefault.aspx

Another goal for the upcoming year is to convene a winter symposium for the 2008-2009 academic year that will focus on research interests of our members, fellowship program development and dive medicine. This symposium will be in the form of a dive trip to the Caribbean with morning dives and afternoon lectures. CME credit will be available. Another goal of the section during the upcoming year is to develop a board review course in Undersea and Hyperbaric Medicine to help prepare board eligible candidates for the exam.

We also have been active with regard to our third objective.  The ACEP Clinical Policy Committee presented a policy statement to the Board that was not supported by members of the section leadership. This policy addresses the management of patients presenting to the emergency department with CO poisoning. Our objections and concerns with regard to the methodology and validity of the policy were discussed with the leadership of the Clinical Policies Committee and the Board Liaisons for the Hyperbaric Medicine Section and the Clinical Policies Committee. The policy was approved by the Board despite objections raised by section leadership. We have prepared a special correspondence outlining our concerns and this manuscript will be published in an upcoming issue of the Annals of Emergency Medicine. You can read the clinical policy at the following web address: https://www.acep.org/practres.aspx?id=30060&coll=1&collid=74

The Undersea and Hyperbaric Medical Society (UHMS) has been active in addressing the issue of indications for hyperbaric oxygen being moved from the "approved" to "experimental" lists for Blue Cross and Blue Shield in some states. The primary concern relates to the conditions of osteoradionecrosis and soft-tissue radiation injury. We will work in conjunction with UHMS and use our voice in ACEP to lobby for the welfare of our patients who suffer from radiation injury to make sure this safe and effective treatment option remains reimbursable and available to them.

Also, I am pleased to let you know that our membership numbers are climbing. The last official count I received from Margaret was 126. Our voice in ACEP is closely tied to our membership numbers so I implore you to encourage your colleagues who have an interest in Undersea and Hyperbaric Medicine to join the section. Encourage fellows to join and I should remind you that emergency medicine residents can join one section at no charge. For membership, please go to the following web address:
https://webapps.acep.org/Membership/SectionApplication.aspx

As we look forward to a busy, active and exciting year for our specialty and section, I hope you get involved and participate by submitting an article to the newsletter, by participating in or attending the winter symposium or board review course, or by encouraging a colleague to join the section. I look forward to serving members to the best of my ability. Do not hesitate to contact me with any inquiries, questions or concerns.

 

 


 

 

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Undersea and Hyperbaric Medicine: A True Sub-specialty of Emergency Medicine

Marvin Heyboer III, MD, FACEP
Co-secretary, Hyperbaric Medicine Section

Emergency medicine is still a relatively young specialty. When board certification in emergency medicine began, there was both a practice track and residency track towards certification. The specialty matured, accredited residency programs grew, and eventually residency training became the only path to board certification from American Board of Medical Specialties (ABMS).

Hyperbaric medicine is undergoing the same transformation. The specialty began board certification in the 1990’s, and fellowships in the field have been developed. More recently, fellowships have been encouraged to become accredited by the ACGME. The practice track and non-accredited fellowship track towards board certification have been extended through 2010. After that time, the American Board of Emergency Medicine (ABEM) and the American Board of Preventive Medicine (ABPM) plan to allow board certification only to those who have completed a fellowship at an accredited program.

It is critical to the specialty that these fellowships succeed and expand in the same way emergency medicine residencies have done in the past. The past year has been a productive one for our fellowship programs. Three fellowships have attained accreditation through ACGME. Over the coming year, we plan to highlight emergency medicine fellowship programs in the field of Undersea and Hyperbaric Medicine (especially those that are currently accredited through ABEM). We are highlighting the program at LSU in this issue.

The following is a current list of emergency medicine fellowships in Undersea and Hyperbaric Medicine.

ACGME Accredited Programs:

University of California San Diego
Karen B. Van Hoesen, MD, FACEP
University of California San Diego
Department of Emergency Medicine
200 West Arbor Drive #8676
San Diego, CA 92103
Phone: 619.543.6463
Fax: 619.543.3115
Email: kvanhoesen@ucsd.edu

Hennepin County Medical Center
Robert E. Collier MD, FACEP
Program Director - HCMC HBM Fellowship
701 Park Avenue South
Minneapolis, MN 55415
Phone: 612.873.7420
Email: colli046@umn.edu

Hospital of University of Pennsylvania
Stephen R. Thom, MD, PhD
University of Pennsylvania
Department of Emergency Medicine
Institute for Environmental Medicine
3620 Hamilton Walk
Philadelphia, PA 19104-6068
Phone: 215.898.9095
Fax: 215.573.7037
Website: www.pennmedicine.org/hup/

Louisiana State University
Paul G. Harch, MD
Attn: Sylvia Cusimano
Section of Emergency Medicine
1816 Industrial Boulevard
Harvey, Louisiana 70058
Phone: 800.330.3693
Email: scusimano@newsouth.net

University of Texas Southwestern Medical School Program
Jeffery Stone, DO
Director, Undersea Hyperbaric Medicine Fellowship Program
Attn: Julie Rogness
University of Texas Southwestern Medical School
7232 Greenville Avenue
Dallas, Texas 75231
Phone: 214.345.7924
Phone: 214.345.4651
Fax: 214.345.4647
Email: juliemartin@texashealth.org
Website: www.wound.com

Non-Accredited Programs:

Long Beach Memorial Medical Center
Stuart S. Miller, MD
Long Beach Memorial Medical Center
Department of Hyperbaric Medicine
2801 Atlantic Avenue
Long Beach, CA 90801
Phone: 562.933.6951
Fax: 562.933.6952

Palmetto Richland Memorial Hospital
Hyperbaric Medicine
5 Richland Medical Park
Columbia, SC 29203
Phone: 803.434.7101
Fax: 803.434.4354
Email: dick.clarke@rmh.edu

 


 

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LSU School Of Medicine, New Orleans
Hyperbaric Medicine Fellowship

Paul G. Harch, MD
Clinical Assistant Professor
Program Director

The LSU School of Medicine Hyperbaric Medicine Fellowship is a diverse, multi-faceted, comprehensive training program in undersea and hyperbaric medicine that consists of sound clinical, didactic, and research components. It was granted accreditation by ACGME this fall for 5 fellowship positions beginning the 2008 academic year fellowship class. This represents the largest number of fellowship positions and largest accredited hyperbaric medicine fellowship in the United States. The strength of the program lies in the combination of expert faculty, exceptional clinical sites, a large volume of indigent and private patients that span the range of accepted and experimental indications, and ample research opportunities.

Our faculty consists of some of the most accomplished physicians in hyperbaric medicine. The most senior faculty member, Dr. Keith Van Meter, is internationally known for his unparalleled experience and knowledge in diving medicine and wound care. He continues to anchor an offshore Gulf of Mexico 24/7 call service for commercial diving accidents, often flying to sites of injury to provide prolonged in-chamber treatment of diving cases in extremis. His experience continues to reinforce the application of deep saturation recompression of severe cases of decompression illness. In the last 10 years his animal research in resuscitation has been award winning on a national level and will soon be advancing to the clinical arena. The publication of this work is in the final revision stage. He serves on the board of the American College of Hyperbaric Medicine, the board of the Undersea and Hyperbaric Medical Society, and lectures internationally on hyperbaric medicine fitness to dive.

Dr. Paul G. Harch, the program director for 16 years and site director for the University Hospital Hyperbaric Department, is widely known for his clinical work in hyperbaric oxygen therapy for chronic brain injury, especially cerebral decompression illness, traumatic brain injury, and pediatric neurology. He has recently duplicated the human experience in chronic traumatic brain injury using an animal model (Brain Res. 2007 Oct 12;1174:120-9. Epub 2007 Aug). He is actively engaged in ongoing clinical research and is focusing his efforts on obtaining funding for research in acute stroke and chronic traumatic brain injury. He is the immediate past president of the International Hyperbaric Medical Society and author of the book, The Oxygen Revolution, (Paul G. Harch, MD and Virginia McCullough. Hatherleigh Press, New York, 4/24/2007). In the past two months he was elected to the boards of the American Association of Health Freedom and the American College for the Advancement of Medicine (ACAM). He will be co-chairing ACAM’s new Hyperbaric Medicine Section.

Dr. Murphy-Lavoie, co-assistant director of the fellowship, has recently been appointed to head a national registry for hyperbaric oxygen treatment of central retinal artery occlusion. Her review in Sydney, Australia of our 20 year experience of HBOT in central retinal artery occlusion resulted in an invitation to present this diagnosis to the HBOT Committee of the UHMS, subsequent approval, and now authorship of the first new indication for HBOT since intracranial abscess in 1996. She serves on the Education Committee of the Undersea and Hyperbaric Medical Society and on the board of the American College of Hyperbaric Medicine. She just co-authored with Dr. David Ulick, a recent hyperbaric medicine fellow, a chapter on diving medicine for the new Adams emergency medicine textbook.

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Dr. LeGros, co-assistant director for the fellowship, is the medical director for Acadian Ambulance, the largest private ambulance service in the country. She is developing the first EMS hyperbaric ambulance in the country to be used in multiple pre-hospital research applications. She is the director of the LSU Emergency Medicine Section’s Emergency Medical Services Fellowship. She holds a PhD in physiology, which adds great depth and complexity to her lectures and bedside teaching.

Dr. Paul K. Staab is the director of the Hyperbaric Medicine and Woundcare Department at West Jefferson Medical Center, the primary fellowship training site. Dr. Staab is also a pharmacist and expert in diabetic foot wound management. He has been the main staff physician for the Diabetic Foot Clinic and annually hosts and lectures at a regional conference on diabetes at West Jefferson Medical Center. He also directs the freestanding clinic at which he, Dr. Harch, and Dr. Van Meter have conducted hyperbaric research and a clinical hyperbaric practice for 22 years. Dr. Alan Wyatt is the co-assistant director of the Hyperbaric and Woundcare Department of West Jefferson Medical Center and primary staff, along with Drs. Harch and Victor Tuckler at the university site. He is an internist with a PhD in neuroscience who has a strong interest in diving medicine. This fall he dove with the Aquarius Habitat scientific team in Florida. He is developing a new hyperbaric medicine board review manual with Drs. Murphy-Lavoie and LeGros. He is joined by co-assistant director of the West Jefferson department Dr. Marcus Clayton who serves as clinical faculty.

In addition, the faculty includes Dr. Victor Tuckler who is a toxicologist and emergency/hyperbaric medicine physician. Dr. Tuckler is director of the toxicology section of the Emergency Medicine Section and is one of the primary staff at the university hyperbaric medicine site with Drs. Harch and Wyatt. Dr. Sean Hardy is a recent addition to our faculty from the fellowship class of 2006-7. He was former chief resident of his emergency medicine residency class in New Orleans and is an avid diver who completed a rotation at the Aquarius Habitat in January of 2007. He serves as faculty at both sites and is the assistant director of the EMS Fellowship. Dr. Hardy is actively involved with the offshore emergency hyperbaric medicine service providing onsite case management with Dr. Van Meter. Dr. Frank Alessi is a senior cardiothoracic and vascular surgeon who transitioned recently from a very active thoracic and vascular surgery practice to attending staff in the Hyperbaric Department at West Jefferson Medical Center. He performs vascular surgery consultations and instructs fellows in surgical debridements and woundcare. His active participation in the department and at teaching Grand Rounds is a significant strength of the program. Dr. Moises is an emergency and hyperbaric physician who assisted Dr. Van Meter in analysis of brain injury in the porcine resuscitation/HBOT experiments. He also completed a pilot trial of HBOT in acute stroke and is primarily a research resource for the fellowship.

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The fellowship consists of 12 months that includes 10 clinical months, 1 research month, and 1 month of vacation. During the 10 clinical months the fellows alternate between the two clinical training sites. Two of the 10 months are devoted to primary call and interaction with diving accidents, rotation to National Oceanographic and Atmospheric Administration Diving Program sites where the fellows learn diving physiology and scientific diving operations, and reading. The research month is devoted to an individual research project and interface with the research staff and facilities at the Baromedical Institute of New Orleans (described below). By the end of the fellowship the fellows have completed a publishable quality work product that is presentable to a regional or national meeting.

Overall, the LSU School of Medicine Hyperbaric Medicine Fellowship Program offers one of the broadest experiences in Undersea and Hyperbaric Medicine in the United States. The primary training site is West Jefferson Medical Center, a parish owned and operated medical center that functions as a tertiary care private institution. It is distinguished by its U.S. News and World Reports’ Top 50 Hospital ranking in the United States for the last three years. The Hyperbaric Medicine Department, a Divers Alert Network (DAN) referral site for all sport diving accidents in the South Central United States and Gulf of Mexico, strengthens an array of excellent programs. The hospital features an air ambulance service that delivers injured commercial divers to the hyperbaric unit. The Hyperbaric and Woundcare department is equipped with a 32 foot dual-lock multiplace chamber, two luxurious 40 inch diameter monoplace chambers, and the full range of support equipment sufficient to provide a single site comprehensive training program for fellows. Departmental patients span the entire range of hyperbaric treated diagnoses, including fitness to dive (divers and chamber personnel), decompression illness, problem wounds, hyperbaric complications, critical illness, and toxic gas exposure, The fellows see over 6,000 wound care visits/year, supervise over 5,000 hyperbaric oxygen treatments, and perform in excess of 150 transcutaneous oxygen measurements.

The affiliated training site is the outpatient Hyperbaric Medicine Department of the Medical Center of Louisiana, New Orleans’, (MCLNO) West Campus (University Hospital). This is a temporary facility since Hurricane Katrina that operates 12h/day 6d/week and sees primarily the indigent population of the New Orleans Metro area. Referrals are accepted from all New Orleans and outlying hospitals. Current census is over 7,000 patient care visits/year divided between HBOT and woundcare. The department consists of two Sechrist monoplace chambers that run at full capacity. A third chamber is in the planning stage. The physical therapy, occupational therapy, and footcare/orthotic department of MCLNO is contiguous with the hyperbaric department. Comprehensive foot woundcare is tightly coordinated with this department and utilizes on-site fabrication of a wide range of foot orthotics to offload and accommodate extremity ulcers. The facility will soon house all of the MCLNO outpatient clinics such that referrals and continuity of care between the surgical and medical specialties will be maximized.

By Spring, 2008 the LSU Hyperbaric Medicine Fellowship will add a fourth site, the inpatient hyperbaric medicine service of University Hospital. This service was available before Hurricane Katrina and was operating at near full capacity treating the spectrum of emergency and chronic hyperbaric medicine indications. Due to University Hospital’s Level I Trauma status the hyperbaric medicine service saw a high proportion of blast and compartment syndrome cases as well as carbon monoxide poisoning. It is expected that this experience will continue with resumption of service in the spring. The department is expected to feature 2 monoplace chambers. It is organizationally and conceptually an integral part of the emergency department which is the training site for the renowned LSU/Charity Hospital Emergency Medicine Residency. The hyperbaric department is staffed by emergency medicine and internal medicine physicians who also specialize in hyperbaric medicine. Fellows are exposed to an astounding range of pathology, which has characterized Charity Hospital and its training programs for decades.

Additionally, the program is associated with the Baromedical Research Institute (BRI) of New Orleans, a not-for-profit hyperbaric research corporation founded by Dr. Van Meter in the 1980s. The BRI has a legacy of cutting edge hyperbaric research that includes resuscitation, chronic brain injury, envenomation, decompression illness, mucormycosis, near-infrared spectroscopy, and exsanguination. It has the highest animal laboratory accreditation (AAALAC-Association for Assessment and Accreditation of Laboratory Animal Care) and is staffed by a full-time Ph.D in biomedical engineering. The most recent research includes a national award winning project in HBOT-induced cardiac resuscitation of swine after 25 minutes of warm cardiac arrest, the first ever demonstration of improvement (HBOT-induced) of chronic brain injury in animals, and HBOT in exsanguination.

The fellowship curriculum is comprehensive didactically and clinically and covers all of the required undersea and hyperbaric medicine specialty topics. Fellows advance their clinical responsibility through informal and formal feedback mechanisms as they rotate through 10 clinical months that include primary and affiliated training sites and diving medicine rotations. In addition, the fellowship includes a research month where fellows work on a project of their choosing. Fellows are exposed to well over 5 hours/week of didactic training and 40 hours/week of direct clinical instruction/oversight. They are exposed to both acute and chronic conditions and simultaneously teach residents, interns, medical students, and diver medics while maintaining their primary skills through employment in their primary specialty. Each fellow operates in a scholarly environment through direct weekly interaction with the faculty who are actively engaged in basic science and clinical research. Research and research methodologies are discussed through conferences, literature review, and interaction with the Ph.D researchers at the BRI. By the end of the fellowship each fellow completes a research project that is presented at a regional or national meeting.

The combination of these two training sites with the BRI, the mix of public indigent and private patients, access to the sport and commercial diving communities in the Gulf of Mexico, a diverse faculty with extensive diving and hyperbaric medicine experience, and active research make this Louisiana State University program extremely strong and diversified. The 100% success rate of our fellows with the Undersea and Hyperbaric Medicine Boards is testament to the strength of the program. The program is currently accepting applications for the 2008-09 fellowship year. We hope you’ll join us.

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Recent Resident Research:

Anderson J, Harch P, LeGros TL. Successful delayed hyperbaric treatment of decompression illness in a sport scuba diver. Louisiana State University Health Science Center, Internal Medicine Research Forum (slide show presentation with videos), February 2003.

Fernandez G, Harch P, Staab P. Delayed HBO treatment in an acute CO poisoning following hurricane Katrina. Undersea Hyper Med. 2006:33(5):340.

Gentry P, VanMeter K, Harch P, et al. Appearance of suspicious skin lesions in a patient undergoing hyperbaric oxygen therapy for treatment of soft tissue radionecrosis secondary to cutaneous T-Cell lymphoma. Undersea Hyper Med. 2004;31(3):350-351.

Glover NR, VanMeter K, LeGros T, et al. Decompression illness presenting as acute psychosis. Undersea and Hyperbaric Medicine Society Annual Research Forum, Sidney, Australia, May 2004.

Gordon DM, TL LeGros, VanMeter K. Treatment of pneumothorax at depth. Undersea Hyper Med. 2005;32(4):260.

Hardy S, Wilson B, Van Meter K, et al. Isolated peripheral CN VII and phrenic nerve palsies following oxygen-enriched therapeutic air saturation decompression: A case report. Undersea and Hyperbaric Medical Society 2007 Annual Scientific Meeting, June 14-16, Maui, Hawaii.

Hardy S, Van Meter K, LeGros TL, et al. Urgent conversion of a deck decompression chamber to a temporary saturation system: Experience in the Gulf. Undersea and Hyperbaric Medical Society 2007 Annual Scientific Meeting, June 14-16, Maui, Hawaii.

Levy S, VanMeter K, Murphy-Lavoie H, et al. Pneumomediastinum and decompression illness in a commercial diver. Louisiana State University Health Science Center, Internal Medicine Research Forum, February 2005.

Madatic J, Barratt D, Murphy-Lavoie H, et al. Occult neurological injury in a professional commercial diver: The difficulty in diagnosing and treating type II decompression sickness of the spinal cord. Undersea Hyper Med. 2005;32(4):233.

Ulick D, Murphy-Lavoie H. Dysbarism. In: Emergency Medicine. Adams, Barton, Collings, DeBlieux, Gisondi, Nadel, Elsevier, 2007, In Press.

Wierzbicki D, Harch PG. Two month delayed hyperbaric recompression of DCS from injury at depth misdiagnosed as musculoskeletal strain and post-concussive syndrome. Undersea and Hyperbaric Medical Society 2007 Annual Scientific Meeting, June 14-16, Maui, Hawaii.

Wilson B, Wierzbicki D, Hardy S, et al. Acute carbon monoxide poisoning from volitional hookah smoke inhalation. Undersea and Hyperbaric Medical Society 2007 Annual Scientific Meeting, June 14-16, Maui, Hawaii.

Wyatt HA, Harch PG, Staab P, et al. Treatment of orbital compartment syndrome with hyperbaric oxygen (HBO2) therapy. Undersea Hyper Med. 2006;33(5):334.

 

 


 

 

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Journal Watch

Reviewer: Marvin Heyboer III, MD, FACEP

Hampson NB, Corman JM. Rate of delivery of hyperbaric oxygen treatments does not affect response in soft tissue radionecrosis. Undersea Hyperbaric Med. 2007. 34(5): 329-334.

This is a study out of Virginia Mason Medical Center, Seattle, Washington. It is a retrospective case series of 65 consecutive patients with STRN of the GI tract (radiation enteritis/proctitis) treated with HBO2 from 1991-2003 and 94 consecutive patients with STRN of the bladder (Radiation Cystitis) treated with HBO2 from 1988-2006. Outcomes were categorized as (1) complete response (2) partial response, or (3) failure.

Patient treatment protocols varied greatly. Patients were offered once or twice daily HBO2 treatment Monday – Friday and once daily treatment Saturday and Sunday. As a result, patients received from 0-12 treatments each week depending on their circumstance. Patients averaged from 1-13 treatments per week over the course of therapy with a median of 5 treatments per week.

There was no significant difference in outcome for those averaging 5 or fewer treatments per week compared with those averaging over 5 treatments per week. Moreover, there was also no significant difference in outcomes for those averaging 3 or fewer treatments per week compared to those averaging 7 or more treatments per week. This was not statistically significant.

The response rate was significantly greater in patients who received 30 or more total HBO2 treatments compared to those who received less than 30 total treatments. This was statistically significant.

Summary: This study suggests that it is appropriate to adjust patient treatment scheduling depending on the capabilities and priorities of each facility. Individual facilities should be allowed to determine whether they treat 5 days a week, 7 days a week, once daily, or twice daily. The total number of HBO2 treatments appears to be of greater importance. This should still be taken with a certain degree of caution to avoid spreading out a patient’s treatments over too long a time period, as at some point one would expect diminishing returns.

Reviewer: Christopher J. Logue, MD

Weaver LK, Valentine KJ, Hopkins RO. Carbon monoxide poisoning: risk factors for cognitive sequelae and the role of hyperbaric oxygen. Am J Respir Crit Care Med. 2007; 176(5):491-497.

This is a follow-up study from the randomized trial that was published in the New England Journal of Medicine back in 2002 from Weaver et al. The study involved 147 patients from the original trial and another 91 patients who did not enroll in the trial (did not receive HBO2). These patients were not enrolled in the trial because they either presented more than 24 hours after their exposure or they declined to participate in the original trial. The purpose of this study is to help better define subgroups of CO poisoned patients that would most likely benefit from HBO2.

The results demonstrate that independent risk factors for developing long-term neurological sequelae include exposure of more than 24 hours and age over 36 years. Analysis of the 75 patients who received HBO2 showed that the incidence of neurological sequelae was specifically reduced in patients over the age of 36 years, those with loss of consciousness and higher COHgb levels. This study can help emergency medicine physicians, toxicologists and hyperbaric medicine physicians better identify patients that are likely to benefit from HBO2 after acute CO poisoning.

 


 

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This publication is designed to promote communication among emergency physicians of a basic informational nature only. While ACEP provides the support necessary for these newsletters to be produced, the content is provided by volunteers and is in no way an official ACEP communication. ACEP makes no representations as to the content of this newsletter and does not necessarily endorse the specific content or positions contained therein. ACEP does not purport to provide medical, legal, business, or any other professional guidance in this publication. If expert assistance is needed, the services of a competent professional should be sought. ACEP expressly disclaims all liability in respect to the content, positions, or actions taken or not taken based on any or all the contents of this newsletter.

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