The following is a summary of ‘’Early hyperbaric oxygen therapy is associated with favorable outcome in patients with iatrogenic cerebral arterial gas embolism: systematic review and individual patient data meta-analysis of observational studies,” published in the July 2023 issue of Critical Care by Fakkert et al.

Hyperbaric oxygen therapy (HBOT) is effective for treating iatrogenic cerebral arterial gas embolism (CAGE), with better outcomes when initiated within 6-8 hours compared to later.

Researchers performed a retrospective study to assess how the timing of HBOT relates to the outcome of iatrogenic CAGE. Their systematic search included studies on time-to-HBOT and outcomes in iatrogenic CAGE patients. They conducted group meta-analyses and individual patient-level analyses to evaluate the relationship between time-to-HBOT and favorable outcomes. Group-level meta-analysis (10 studies, 263 patients) revealed that patients with favorable outcomes received HBOT 2.4 hours earlier (95% CI 0.6-9.7) compared to those with unfavorable outcomes. The individual patient analysis (8 studies, 126 patients) using a generalized linear mixed effects model demonstrated a significant relationship between time-to-HBOT and the probability of favorable outcomes (P = 0.013), which remained significant after adjusting for the severity of manifestations (P= 0.041). The probability of favorable outcomes declined from approximately 65% with immediate HBOT initiation to 30% when delayed for 15 hours.

This study suggested that early initiation of HBOT in iatrogenic CAGE is crucial, as delayed treatment reduces the likelihood of favorable outcomes.

Source: ccforum.biomedcentral.com/articles/10.1186/s13054-023-04563-x