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
Abstract Background Iatrogenic cerebral arterial gas embolism (CAGE) caused by invasive medical procedures may be treated with hyperbaric oxygen therapy (HBOT). Previous studies suggested that initiation of HBOT within 6–8 h is associated with higher probability of favorable outcome, when compared t...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-07-01
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| Series: | Critical Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13054-023-04563-x |
| _version_ | 1797778840561385472 |
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| author | Raoul A. Fakkert Noa Karlas Patrick Schober Nina C. Weber Benedikt Preckel Robert A. van Hulst Robert P. Weenink |
| author_facet | Raoul A. Fakkert Noa Karlas Patrick Schober Nina C. Weber Benedikt Preckel Robert A. van Hulst Robert P. Weenink |
| author_sort | Raoul A. Fakkert |
| collection | DOAJ |
| description | Abstract Background Iatrogenic cerebral arterial gas embolism (CAGE) caused by invasive medical procedures may be treated with hyperbaric oxygen therapy (HBOT). Previous studies suggested that initiation of HBOT within 6–8 h is associated with higher probability of favorable outcome, when compared to time-to-HBOT beyond 8 h. We performed a group level and individual patient level meta-analysis of observational studies, to evaluate the relationship between time-to-HBOT and outcome after iatrogenic CAGE. Methods We systematically searched for studies reporting on time-to-HBOT and outcome in patients with iatrogenic CAGE. On group level, we meta-analyzed the differences between median time-to-HBOT in patients with favorable versus unfavorable outcome. On individual patient level, we analyzed the relationship between time-to-HBOT and probability of favorable outcome in a generalized linear mixed effects model. Results Group level meta-analysis (ten studies, 263 patients) shows that patients with favorable outcome were treated with HBOT 2.4 h (95% CI 0.6–9.7) earlier than patients with unfavorable outcome. The generalized linear mixed effects model (eight studies, 126 patients) shows a significant relationship between time-to-HBOT and probability of favorable outcome (p = 0.013) that remains significant after correcting for severity of manifestations (p = 0.041). Probability of favorable outcome decreases from approximately 65% when HBOT is started immediately, to 30% when HBOT is delayed for 15 h. Conclusions Increased time-to-HBOT is associated with decreased probability of favorable outcome in iatrogenic CAGE. This suggests that early initiation of HBOT in iatrogenic CAGE is of vital importance. |
| first_indexed | 2024-03-12T23:23:21Z |
| format | Article |
| id | doaj.art-792c03fd9cc941198ee3c9afbf864ae0 |
| institution | Directory Open Access Journal |
| issn | 1364-8535 |
| language | English |
| last_indexed | 2024-03-12T23:23:21Z |
| publishDate | 2023-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Critical Care |
| spelling | doaj.art-792c03fd9cc941198ee3c9afbf864ae02023-07-16T11:18:24ZengBMCCritical Care1364-85352023-07-012711710.1186/s13054-023-04563-xEarly 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 studiesRaoul A. Fakkert0Noa Karlas1Patrick Schober2Nina C. Weber3Benedikt Preckel4Robert A. van Hulst5Robert P. Weenink6Department of Anesthesiology, Amsterdam UMC Location University of AmsterdamHyperbaric Medicine, Amsterdam UMC Location University of AmsterdamDepartment of Anesthesiology, Amsterdam UMC Location Vrije Universiteit AmsterdamLaboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC Location University of AmsterdamDepartment of Anesthesiology, Amsterdam UMC Location University of AmsterdamDepartment of Anesthesiology, Amsterdam UMC Location University of AmsterdamDepartment of Anesthesiology, Amsterdam UMC Location University of AmsterdamAbstract Background Iatrogenic cerebral arterial gas embolism (CAGE) caused by invasive medical procedures may be treated with hyperbaric oxygen therapy (HBOT). Previous studies suggested that initiation of HBOT within 6–8 h is associated with higher probability of favorable outcome, when compared to time-to-HBOT beyond 8 h. We performed a group level and individual patient level meta-analysis of observational studies, to evaluate the relationship between time-to-HBOT and outcome after iatrogenic CAGE. Methods We systematically searched for studies reporting on time-to-HBOT and outcome in patients with iatrogenic CAGE. On group level, we meta-analyzed the differences between median time-to-HBOT in patients with favorable versus unfavorable outcome. On individual patient level, we analyzed the relationship between time-to-HBOT and probability of favorable outcome in a generalized linear mixed effects model. Results Group level meta-analysis (ten studies, 263 patients) shows that patients with favorable outcome were treated with HBOT 2.4 h (95% CI 0.6–9.7) earlier than patients with unfavorable outcome. The generalized linear mixed effects model (eight studies, 126 patients) shows a significant relationship between time-to-HBOT and probability of favorable outcome (p = 0.013) that remains significant after correcting for severity of manifestations (p = 0.041). Probability of favorable outcome decreases from approximately 65% when HBOT is started immediately, to 30% when HBOT is delayed for 15 h. Conclusions Increased time-to-HBOT is associated with decreased probability of favorable outcome in iatrogenic CAGE. This suggests that early initiation of HBOT in iatrogenic CAGE is of vital importance.https://doi.org/10.1186/s13054-023-04563-xAir embolismHyperbaric oxygenationIatrogenic diseaseEmbolic stroke |
| spellingShingle | Raoul A. Fakkert Noa Karlas Patrick Schober Nina C. Weber Benedikt Preckel Robert A. van Hulst Robert P. Weenink 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 Critical Care Air embolism Hyperbaric oxygenation Iatrogenic disease Embolic stroke |
| title | 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| topic | Air embolism Hyperbaric oxygenation Iatrogenic disease Embolic stroke |
| url | https://doi.org/10.1186/s13054-023-04563-x |
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