HBOT chamberThe BART Foundation aims to promote better outcomes for brain injury survivors by answering three questions – which alternative therapies are likely to work, where can they be found, and how can they be afforded? One of the ways we fulfill our mission is by carefully watching global research and clinical trial outcomes and sharing that information, in user-friendly language, with the TBI/ABI community. Hyperbaric oxygen therapy (HBOT) is one of the safe, alternative therapies the BART Foundation believes may help brain injury survivors. Perhaps if HBOT becomes more widely accepted as a treatment option, TBI/ABI/PCS survivors will be able to gain better access to this life-changing treatment.

We wanted to share this recent article published in the European Society of Medicine featuring the work of Amir Hadanny and Shai Efrat (Sagol Center for Hyperbaric Medicine and Research, Shamir Medical Center, Zerifin, Israel), and Joseph Maroon* (clinical professor of neurological surgery and the Heindl Scholar in Neuroscience at the University of Pittsburgh School of Medicine). This online article is a comprehensive literature review of HBOT applications for the treatment of patients with acute, subacute, and chronic TBI published between 1969 to April 2023. Articles were categorized into acute-subacute TBI and chronic TBI and further classified into low, medium, or high-level quality.

Results: There was high-level evidence, including nine randomized controlled trials, one meta-analysis, and two prospective studies evaluating the clinical effects of HBOT in patients suffering from TBIs in acute and subacute settings. Mortality was significantly reduced in all studies that used it, while favorable functional outcomes in survivors showed mixed results.

In chronic severe TBI, there is low to moderate evidence, including two uncontrolled prospective studies, two cohort studies, and eight case reports suggesting improved outcomes.

In chronic mild TBI, there is high-level evidence, including seven randomized controlled trials, and six prospective studies, suggesting significant improvement in cognitive function, symptoms, and quality of life.

Conclusions: HBOT may be recommended in acute moderate-severe TBI patients. However, further studies are needed to both evaluate outcomes and to determine the optimal treatment protocols for the different types of injuries.

HBOT should be recommended in chronic traumatic brain injury for a selected group of patients suffering from prolonged post-concussion syndrome who have clear evidence of metabolic dysfunctional brain regions as determined by neuroimaging. Patients should be properly evaluated by standardized cognitive tests and functional brain imaging.

*More about Joseph C. Maroon, MD

Dr. Maroon is a clinical professor of neurological surgery and the Heindl Scholar in Neuroscience at the University of Pittsburgh School of Medicine. He received his medical and neurosurgical training at Indiana University, Georgetown University, Oxford University in England, and the University of Vermont. He is board-certified in neurological surgery. Dr. Maroon’s clinical and research interests are in the development of minimally invasive surgical procedures for the brain and spine; the prevention and treatment of traumatic injuries to the central nervous system; innovative approaches to pituitary and brain tumors; and complementary approaches to inflammatory diseases of aging.

In cooperation with neuropsychologist Mark Lovell, Ph.D., Dr. Maroon co-developed ImPACT® (Immediate Post-Concussion Assessment and Cognitive Testing), the first computerized system to determine concussion severity and the timing for return to contact sports. An avid lifelong athlete, Dr. Maroon has served as team neurosurgeon for the Pittsburgh Steelers for 25 years.

Dr. Maroon has published more than 260 peer-reviewed papers and five books and has received several honors, including election by his peers as president of the Congress of Neurological Surgeons, North America’s largest society of neurosurgeons. He is frequently quoted as an expert source by national media, including the New York Times, USA Today, Associated Press, ESPN, Sports Illustrated, and ABC News Nightline.