title: Protective effects of hyperbaric oxygen therapy (HBO2) in cardiac care--A proposal to conduct a study into the effects of hyperbaric pre-conditioning in elective coronary artery bypass graft surgery (CABG).
abstract: We review and report on accumulated data showing the benefits offered by hyperbaric oxygen (HBO2) therapy as an adjunct in the treatment of coronary artery bypass graft (CABG) patients. It has been shown that ischemia-reperfusion injury is deleterious to the myocardium, causing left ventricular dysfunction, structural damage to the myocytes and endothelial cells, myocardial stunning, reperfusion arrhythmias and potentially irreversible injury. There is a substantial body of evidence pointing to the role of HBO2 in mitigating the harmful effects of ischemia-reperfusion injury. Specifically, we review evidence from a number of studies which clearly point to both clinical and cost benefits HBO2 offers when used to precondition non-emergent patients having on-pump coronary arterial bypass graft surgery. Study data show that adding adjunctive HBO2 into the plan of care leads to improved myocardial function, reduces length of stay in the ICU, and limits post-surgical complications. Further, it has only minimal impact on the presurgical preparation, i.e., time must be allowed for the hyperbaric treatment(s), and no role in the surgery or post-surgical care of the patient. The studies pointing to clinical and cost benefit of preconditioning have been conducted outside the United States. Given the pressure on costs in all areas of health care, it seems that a therapeutic approach, which has been shown to be of benefit in both animal and human trials over the course of many years, should attract funding for a properly structured study designed to test whether significant and simultaneous improvements in clinical outcomes and cost reductions can be achieved within the framework of a U.S. healthcare facility.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Allen
authors.forename: Edward
authors.initials: E
authors.lastname: Golembe
authors.forename: Scott
authors.initials: S
authors.lastname: Gorenstein
authors.forename: Glenn J
authors.initials: GJ
authors.lastname: Butler
mesh_terms: D000818:Animals; D001026:Coronary Artery Bypass; D003365:Costs and Cost Analysis; D017558:Elective Surgical Procedures; D006801:Humans; D006931:Hyperbaric Oxygenation / Q000379:methods*; D019157:Ischemic Preconditioning, Myocardial / Q000191:economics / Q000379:methods*; D007902:Length of Stay; D017202:Myocardial Ischemia / Q000628:therapy; D015428:Myocardial Reperfusion Injury / Q000209:etiology / Q000517:prevention & control*; D015427:Reperfusion Injury / Q000209:etiology / Q000517:prevention & control