Hyperbaric Oxygen For Acute Ischemic Stroke:a Systematic Review Of Randomized Controlled Trials

Objectives: o assess whether Hyperbaric oxygen (HBO) treatment can improve activities of daily living in patients with acute ischemic stroke without increasing death and other adverse events; To assess safety of HBO treatment in acute ischemic stroke; (3)To assess whether HBO can improve neurologic deficit and quality of live in patients with acute ischemic stroke.Methods: A systematic review of all the relevant randomized controlled trials (RCTs) was performed. We searched the Cochrane Controlled Trials Register (CCTR, 2001. Issue 4), Medline-disk (1980 to 2001.12), CBM-disk (Chinese biological medical database, 1974 to 2001.12) and Chinese Trials Register of Neurologic disease, In addition, we tracked down the reference lists of papers related to HBO. We included all completed unconfounded truly randomized trials or quasi-randomized trials (CCTs) in patients with acute ischemic stroke comparing hyperbaric oxygen with control (placebo or open control) started within 30 days of the stroke onset. Two reviewers independently assessed trial eligibility, quality and extracted the data. The same two reviewers assessed the methodological quality of each trial by recording details of the randomization method, allocation concealment, blinding, whether an intention-to-treat analysis was possible from the published data and the number of patients who were lost to follow-up. The Peto method was used for analysis.Results: Twenty-three completed RCTs or CCTs have been identified, 18 trials (include 2040 patients) met the inclusion criteria. There were nonsignificant trends in favor of HBO in death from any cause and death or disability at the end of trial follow-up. The adverse events were obviously more in the HBO group than in the control group (2.82% VS 0; Odds ratio (OR) 5.54; 95% confidence interval (CI) 2.09 to 14.68; P = 0.006). HBO was associated with a significant reduction in early deaths [0 VS 11%; OR 0.12; 95% CI 0.02 to 0.90; P = 0.04] suggesting that treatment of 9 patients would avoid 1 early deaths. There were more patients who have improved neurologic deficit at the end of treatment period in the HBO group (94.88% VS 79.18%; OR 4.37; 95% CI 3.30 to 5.77; PO.00001);Conclusion: There were too few patients and poor methodological quality of trials to draw reliable conclusions from the present data. Although HBO treatment appeared promising, the efficacy and safety of HBO in the treatment of acute ischemic stroke would be tested by more high-quality, large scale RCTs in future.