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36 Hyperbaric Oxygenation Therapy KCE Reports 74
3.4.15 Exceptional anaemia
3.4.15.1 Short description of the condition
Patients with an important loss of red blood cells through haemorrhage, haemolysis or
aplasia, may experience suboptimal or even inadequate oxygen carrying capacity by the
blood.
3.4.15.2 Summary of the evidence
Where safely available as in Western Europe, the transfusion of red blood cells is the
most obvious answer to this problem. However, some people might refuse blood
transfusions upon religious grounds, although this problem occurs less in Europe than
for example in the US. Trust in the safety of locally obtained donor blood also might
play an important role in the acceptance or refusal of patients to receive transfusions,
but again this should be no problem in most European countries.
Not surprisingly, the indication of exceptional anaemia is only accepted by UHMS in
exceptional cases where the patient cannot receive or refuses to accept a transfusion, 8
but this indication is not withheld by ECHM. 9 The evidence for this indication is mainly
based on animal models and on small human case series and case reports. 8 A review of
this observational evidence found generally positive results. 65
3.4.16 Miscellaneous indications (not accepted by ECHM nor by UHMS)
Acute Coronary
Syndrome
Apart from the above mentioned accepted indications by ECHM, UHMS or both, there
are numerous other indications, often based on little or no evidence.
In Table 6 those indications that were covered by existing technology assessments or
meta-analyses are shown and we indicate the most relevant references and a short
summary of the main conclusions.
Table 6. Miscellaneous indications for HBOT (only when treated in existing
technology assessment or meta-analyses)
Thesis: The Evidence Basis of Diving and Hyperbaric Medicine,
chapter 13 1
Cochrane review: Hyperbaric oxygen therapy for acute coronary
syndrome. 28
Oxigenoterapia Hiperbárica: Utilidad Diagnóstica e Indicaciones
(IECS 2006) 38
Uses of Hyperbaric Oxygen Therapy (AHRQ 2006) 14
Short summary of the evidence: very low quality evidence from very small trials for a lower risk of
major adverse cardiac events and for a more rapid relieve from pain. No significant effect on
mortality.
Thesis: The Evidence Basis of Diving and Hyperbaric Medicine,
chapter 15 1
Cochrane review 2005: Hyperbaric oxygen therapy for acute
ischaemic stroke. 25
Oxigenoterapia Hiperbárica: Utilidad Diagnóstica e Indicaciones
(IECS 2006) 38
Uses of Hyperbaric Oxygen Therapy (AHRQ 2006) 14
Acute Ischemic Stroke
Carson et al. 66
Short summary of the evidence: no evidence for improved clinical outcomes when applied during the
acute presentation of ischemic stroke. Evidence from three RCTs is insufficient but clinical benefit
does not seem likely.
Acute Traumatic Brain
Injury
Thesis: The Evidence Basis of Diving and Hyperbaric Medicine,
chapter 17 1
Cochrane review 2004: Hyperbaric oxygen therapy for the adjunctive
treatment of traumatic brain injury. 33
Oxigenoterapia Hiperbárica: Utilidad Diagnósticae Indicaciones (IECS
2006) 38
Uses of Hyperbaric Oxygen Therapy (AHRQ 2006) 14