Hyperbaric Oxygen Therapy for Carbon Monoxide Poisoning

Overseen By Jesse Hill

Age: Any Age

Sex: Any

Trial Phase: Academic

Sponsor: University of Alberta

Disqualifiers: Obtunded, Mechanically ventilated, Pregnant, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 1

Duration: 24 hours

300 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests the optimal frequency of hyperbaric oxygen therapy (breathing pure oxygen in a pressurized room) for treating carbon monoxide poisoning. Some patients will receive one treatment, while others will receive three, to determine which approach better aids brain recovery. Adults referred to a hyperbaric unit for carbon monoxide poisoning who are alert can join this trial. As an unphased trial, it offers patients the chance to contribute to important research that could enhance treatment protocols for carbon monoxide poisoning.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.

What prior data suggests that hyperbaric oxygen therapy is safe for treating carbon monoxide poisoning?

Research has shown that hyperbaric oxygen therapy, which involves breathing pure oxygen in a pressurized room, is generally safe for most people. Studies have found that it can reduce the risk of long-term brain problems after carbon monoxide poisoning. For example, one study reported a 46% decrease in memory and thinking issues six weeks after treatment.

While hyperbaric oxygen therapy can help with brain-related issues, it does not necessarily increase survival rates. It is important to know that, although this treatment is commonly used, experts have different opinions about its overall benefits.

Side effects are usually minor and may include ear discomfort or sinus pain due to pressure changes during treatment. These effects are generally manageable and not serious.

Understanding the safety and benefits of hyperbaric oxygen therapy can help prospective trial participants make an informed decision. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about hyperbaric oxygen therapy (HBO) for treating carbon monoxide poisoning because it offers a unique approach compared to standard treatments like normobaric oxygen therapy. HBO involves breathing pure oxygen in a pressurized chamber, which increases the amount of oxygen in the blood more effectively and can accelerate the removal of carbon monoxide from the bloodstream. This method may reduce the risk of long-term neurological damage, a common concern with carbon monoxide poisoning. The trial is also exploring different HBO protocols, such as a single treatment versus three treatments, to determine the most effective regimen, offering hope for more tailored and effective interventions.

What evidence suggests that hyperbaric oxygen therapy could be effective for carbon monoxide poisoning?

Studies have shown that hyperbaric oxygen therapy (HBO) can help treat carbon monoxide poisoning. Research indicates that HBO reduces the risk of thinking and memory problems by 46% after carbon monoxide exposure. In this trial, participants will receive either a single HBO treatment or three HBO treatments. One study found that patients who received HBO had fewer long-term brain issues. Another report highlighted that more than three HBO sessions greatly lowered the chance of developing brain problems. Overall, HBO is considered helpful in preventing lasting brain damage from carbon monoxide poisoning. ^{2 6 7 8 9}

Who Is on the Research Team?

Brian Rowe, MD, MSc, CCFP (EM), FCCP

Principal Investigator

Professor in the Department of Emergency Medicine, Faculty of Medicine & Dentistry, College of Health Sciences, at the University of Alberta

Are You a Good Fit for This Trial?

Adults over 17 years old who have been referred to a Hyperbaric Unit for acute carbon monoxide poisoning are eligible for this trial. Specific details about who cannot participate were not provided.

Inclusion Criteria

I am over 17 and have been referred for treatment due to carbon monoxide poisoning.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

Treatment

Participants receive either 1 or 3 hyperbaric oxygen treatments for carbon monoxide poisoning

24 hours

1-3 visits (in-person)

Follow-up

Participants are monitored for safety and effectiveness after treatment, focusing on delayed neurologic sequelae

6 months

Multiple visits (in-person and virtual)

What Are the Treatments Tested in This Trial?

Interventions

• Hyperbaric Oxygen Therapy

Trial Overview The trial is testing whether one or three hyperbaric oxygen treatments are more effective in treating carbon monoxide poisoning. Patients will be randomly assigned to receive either one treatment or three treatments, and their neurological outcomes will be compared.

How Is the Trial Designed?

Group I: Three HBO treatments Experimental Treatment 1 Intervention

The exact parameters of each dive will be left to individual clinicians. Commonly used treatments would be: 3 treatments: Weaver protocol or similar variation (i.e. 100% oxygen at 3 atmospheres for 90 minutes with two 10-minute air breaks every 30 minutes. This will be repeated every 8 hours until 3 treatments are complete.)

Group II: Single HBO treatment Active Control 1 Intervention

The exact parameters of each dive will be left to individual clinicians. Commonly used treatments would be: 1 treatment: 100% oxygen at 2.8 atmospheres for 30 minutes followed by a 10-minute air break, then 100% oxygen at 2 atmospheres for 60 minutes with one 10-minute air break after 30 minutes

Who Is Running the Clinical Trial?

University of Alberta

Lead Sponsor

Trials

957

Recruited

437,000+

Published Research Related to This Trial

In a study of 172 patients with acute carbon monoxide poisoning, hyperbaric oxygen therapy resulted in a 100% total effective rate, with 93% of patients fully cured and 7% showing improvement.

Administering hyperbaric oxygen therapy within 6 hours of poisoning led to a 100% cure rate, significantly higher than the 78.9% cure rate for those treated after 6 hours, highlighting the importance of early intervention.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Clinical effect of hyperbaric oxygen therapy on groupment acute carbon monoxide poisoning]. Deng, DH., You, ZQ., Qi, B.[2013]

A patient with severe carbon monoxide poisoning (CO-Hb concentration of 82%) was successfully treated with hyperbaric oxygen (HBO) therapy, despite experiencing cardiac arrest during decompression due to complications like acidosis and elevated potassium levels.

After completing HBO therapy, the patient showed no neurological issues three months post-treatment, indicating the efficacy of HBO therapy in preventing delayed neurological sequelae in severe CO poisoning cases.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Hyperbaric oxygen for carbon monoxide poisoning: case report of severe poisoning due to exhaust fumes]. Erdmann, M., Schöppenthau, H., Büttner, J.[2021]

Hyperbaric oxygen therapy (HBOT) is strongly supported by extensive research as an effective treatment for acute carbon monoxide poisoning, based on recent clinical studies and trials.

HBOT should be administered at a pressure of 2.5-3.0 atm absolute to optimize its therapeutic effects in treating carbon monoxide toxicity.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Hyperbaric oxygen should be used for carbon monoxide poisoning. Sethuraman, K., Thom, SR.[2023]

Hyperbaric oxygen (HBO) therapy is recommended for all carbon monoxide (CO) poisoning victims who are unconscious upon arrival at the emergency ward, as it facilitates rapid reoxygenation of tissues and accelerates CO elimination.

Despite existing literature on CO poisoning treatment, there is a significant need for more clinically controlled studies to better understand the efficacy and safety of HBO therapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Treatment of carbon monoxide poisoning. Background and guidelines for oxygen therapy]. Ahrenkiel, JL., Jessen, B.[2017]

Patients with carbon monoxide poisoning need thorough assessment and education before receiving hyperbaric oxygen therapy to ensure safety and effectiveness.

Monitoring physiological changes after hyperbaric oxygen treatment is crucial for evaluating the patient's response and recovery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Carbon monoxide poisoning: hyperbaric oxygenation preparations. Scherb, BJ.[2019]

Hyperbaric oxygen therapy (HBOT) significantly increases oxygen levels in the body and is effective for treating conditions like decompression illness and arterial air embolism, but its use for carbon monoxide poisoning in children is less well-established than in adults.

Due to their higher metabolic rates and developing nervous systems, infants and children may be more vulnerable to carbon monoxide poisoning, suggesting that special considerations are necessary when using HBOT in these populations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Hyperbaric oxygen therapy in childhood carbon monoxide poisoning. Liebelt, EL.[2019]

Hyperbaric oxygen therapy is effective in treating patients with carbon monoxide poisoning, as shown in a study of 34 patients who experienced various sources of poisoning, primarily from faulty heating systems.

Patients with poorer outcomes after treatment had higher serum CK levels, lower Glasgow coma scale scores, and longer delays in receiving first aid and hyperbaric therapy, highlighting the importance of timely intervention.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Treatment of carbon monoxide poisoning with hyperbaric oxygen. Hsu, LH., Wang, JH.[2015]

Hyperbaric oxygen therapy (HBOT) did not significantly reduce in-hospital mortality in patients with carbon monoxide poisoning, with rates of 0.8% in the HBOT group compared to 1.2% in the control group.

However, patients receiving HBOT showed improved mental status and activities of daily living at discharge, indicating potential benefits for recovery, especially in those with non-severe poisoning.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Hyperbaric oxygen therapy and mortality from carbon monoxide poisoning: A nationwide observational study. Nakajima, M., Aso, S., Matsui, H., et al.[2020]

Approximately 1,500 patients with carbon monoxide poisoning are treated with hyperbaric oxygen therapy (HBO2) annually in the US, a number that has remained stable since 1992.

Only 23% of treatment facilities routinely administer more than one HBO2 session per patient, indicating variability in treatment protocols among facilities.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Hyperbaric treatment of patients with carbon monoxide poisoning in the United States. Hampson, NB., Little, CE.[2022]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC7066484/

Hyperbaric oxygen for carbon monoxide poisoning - PMC Several unblinded non‐randomized trials have suggested that the use of hyperbaric oxygen (HBO) prevents the development of neurological sequelae.

2. nejm.org nejm.org/doi/full/10.1056/NEJMoa013121

Hyperbaric Oxygen for Acute Carbon Monoxide Poisoning Hyperbaric-oxygen therapy reduced the frequency of cognitive sequelae by 46 percent, as assessed six weeks after acute, symptomatic carbon monoxide poisoning. ...

3. nature.com nature.com/articles/s41598-021-98539-y

Real-world effectiveness of hyperbaric oxygen therapy for ... We found the patients who received more than three HBOT sessions between CO poisoning and the onset of DNS (76.2% vs 17.1%; P < 0.0001) and ...

4. uptodate.com uptodate.com/contents/carbon-monoxide-poisoning

Carbon monoxide poisoning - UpToDate Six weeks after presentation, cognitive sequelae were less common in the group treated with HBO (25 versus 46 percent, OR 0.39, 95% CI 0.2-0.78) ...

5. ahajournals.org ahajournals.org/doi/10.1161/circ.136.suppl_1.17907

Abstract 17907: Clinical Outcomes and Mortality Impact of ... Hyperbaric oxygen therapy (HBO2) has shown benefit on reducing the long-term neurological sequelae of CO poisoning but has never demonstrated ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC6005724/

Clinical Outcomes and Mortality Impact of Hyperbaric ... Hyperbaric oxygen therapy (HBO2) has shown benefit on reducing the long-term neurological sequelae of CO poisoning but has not demonstrated improved survival.

7. bpspubs.onlinelibrary.wiley.com bpspubs.onlinelibrary.wiley.com/doi/10.1111/bcp.15603

Hyperbaric oxygen should not be used routinely for carbon ... Hyperbaric oxygen therapy is associated with lower short- and long-term mortality in patients with carbon monoxide poisoning.

8. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/16180928/

Hyperbaric oxygen for carbon monoxide poisoning Hyperbaric oxygen (HBO) enhances CO elimination and has been postulated to reduce the incidence of neurological sequelae.

9. eurjmedres.biomedcentral.com eurjmedres.biomedcentral.com/articles/10.1186/s40001-025-02387-9

Hyperbaric oxygen therapy for acute carbon monoxide ... This study aimed to evaluate the effects of coma on the prognosis and delayed encephalopathy in patients with acute carbon monoxide poisoning (DEACMP)