Hyperbare Zuurstoftherapie: Rapid Assessment - KCE

KCE Reports 74 Hyperbaric Oxygenation Therapy 35
The HAS, 37 the IECS, 38 and the AHRQ assessments come to similar conclusions. 14
Within the COST B14 program (see before), a European RCT for HBOT in the acute
treatment of sudden idiopathic sensorineural hearing loss (study co-ordinator: A.
Barthelemy, Marseille, France) is reported to have started in September 2002 with
seven centres participating and 56 patients have been included (information from
2005). 42 However, no results have been found.
3.4.12 Acute ophthalmological ischemia
3.4.12.1 Short description of the condition
Central retinal artery occlusion can result in a sudden interruption of the blood supply
to the retina, causing unilateral loss of vision. This is a rare disease usually occurring
between ages 50 to 80, with sudden, painless, a unilateral visual field defects, sometimes
preceded by transient episodes of vision loss (amaurosis fugax). 61 This disease is most
often cased by embolism of the retinal artery. Visual prognosis is poor and attempted
treatment is based on medical treatment trying to improve perfusion of the retina.
3.4.12.2 Summary of the evidence
The ECHM considers HBOT optional in acute ophtalmological ischemia (type 3, level C
recommendation). 9 The indication is not mentioned in the UHMS guidelines. 8 The HAS
report takes over the ECHM recommendation, 37 while the IECS report refers to an
uncontrolled pilot trial with 21 patients in Germany from Weinberger et al., but
without solid conclusions. 38, 62 A STEER report from 2002 found only two retrospective
comparisons of case series, one with 16 patients (eight with HBOT but without
randomisation) and a second with 35 patients treated with HBOT compared to 37
patients treated in a centre where no HBOT was available. The report concludes that
no reliable evidence about the benefits of HOBT could be found in people with acute
retinal ischemia. Again, it is concluded that RCTs are feasible and should be carried out.
3.4.13 Neuroblastoma stage IV
3.4.13.1 Short description of the condition
Neuroblastoma is a cancer that arises in immature nerve cells and affects mostly infants
and children. Stage 4 is a primary tumour with dissemination to distant lymph nodes,
bone, bone marrow, liver, skin, and/or other organs. 63
3.4.13.2 Summary of the evidence
According to the ECHM, adjuvant HBOT for this indication should be considered
although no RCTs are available to support this. 9 The UHMS does not mention this
indication. 8
The HAS report mainly follows the ECHM recommendation, 37 while neither the AHRQ
14, 38
nor the IECS report do not mention this indication.
3.4.14 Pneumatosis Cystoides Intestinalis
3.4.14.1 Short description of the condition
Pneumatosis Cystoides Intestinalis (PCI) is a rare disease and describes the presence of
gas-containing cysts in the bowel wall. It is a radiographic finding and not a diagnosis, as
the aetiology varies from benign conditions to fulminant gastrointestinal disease. 64
3.4.14.2 Summary of the evidence
For the ECHM, HBOT may be used in selected cases of pneumatosis cystoides
intestinalis as an alternative to surgery, when there is no sign of acute complications
such as perforation, peritonitis and bowel necrosis (type 3, level C recommendation). 9
The UHMS does not mention this indication in its guidelines. The HAS report mainly
confirms the indication from ECHM, without additional evidence. 37