EUROPEAN COMMITTEE FOR HYPERBARIC MEDICINEEUBS & ECHM position statementon the use of Hyperbaric Oxygen Therapy (HBOT)
for the treatment of COVID-19 patients
This Position Statement complements a previous Statement (“ECHM position on Hyperbaric Oxygen Therapy(HBOT) in multiplace hyperbaric chambers during coronavirus disease (COVID-19) outbreak”, 16th March 2020),
which remains fully valid. Concerns regarding transmission and infection risk in hyperbaric chambers were also
addressed in this first Position Statement. The present Position Statement addresses the use of HBOT as atreatment modality for COVID-19 patients.

The possibility that HBOT may have a beneficial effect in the treatment of certain patients with COVID-19 cannot
be excluded and recent, although very limited case study reporting, suggest a possible effect in ameliorating
patient symptoms. The mode of action of HBOT could be due to mechanisms such as e.g. alleviating the oxygen
debt caused by the ventilation/perfusion mismatch, reducing the inflammatory reactions and/or the effect ofSARS-CoV2 on the oxygen-carrying capacities of hemoglobin, or other mechanisms which are still insufficiently
documented in this setting and thus remain speculative in many aspects.

The current level of anecdotal reporting does not allow for recommendations nor the issuing of guidelines
with respect to the use of HBOT in the specific treatment of covid-19.

Multiple clinical research projects using HBOT as adjuvant therapy in COVID-19 are currently being conductedworldwide. EUBS and ECHM welcome and encourage the use of HBOT as part of preplanned and ethicallyapproved randomized trials. It should be emphasised that in order to achieve clinically relevant conclusions, any
study on HBOT in COVID-19 should at least:1.

be approved by an Institutional (Ethics) Review Board2.

have a randomized study protocol, with predefined statistical analysis and patient recruitment plan,with a power calculation on the primary patient outcome, and a control group“The goals of the ECHM are to study and define common indications for hyperbaric therapy, research andtherapy protocols, common standards for therapeutics and technical procedures, equipment and personnel,
cost-benefit and cost-effectiveness criteria, to act as representative body with European health authorities, andto promote cooperation among scientific organizations involved in Diving and Hyperbaric Medicine.”
www.ECHM.org

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give a “hyperbaric” oxygen dose, with reporting of pressure and time of each session, as well as thetotal number of sessions

4.

monitor objective parameters for evaluating the severity of the disease and the clinical and biologicalstatus of the patient5.

and record any adverse effects to the patient or the personnel

Using HBOT only for adjunctive oxygenation, instead of providing optimal oxygen therapy and ventilatory
support in normobaric conditions, is currently a non-accepted approach.

There are published standards and recommendations for giving ventilatory support to COVID-19 patients
prepared by European and worldwide organisations and societies for anaesthesiology and intensive care. They
should be followed as they represent the best knowledge in the field.
For the time being, in accordance with the ECHM Consensus Conference 2016 recommendations for conditions
in which HBOT is considered not to be indicated 1, we propose that HBOT is used for COVID-19 patients outside
a research setting ONLY after careful consideration of the benefit/risk balance for each specific patient and theabsence of possible alternative treatments, recognising that HBOT may be harmful by withholding/interrupting
essential supportive treatments or exposing staff and other patients to a risk of SARS-CoV2 infection.
This would be a case-by-case decision based on specific local circumstances and is NOT in any way endorsed
by EUBS nor ECHM.
In case of any doubts, please contact the ECHM (www.ECHM.org) or EUBS (www.eubs.org).
Recommendations issued on 30th April 2020.

On behalf of the ECHM:/-/ signature/-/ signature/-/ signature

Jacek Kot

Alessandro Marroni

Wilhelm Welslau

President

Vice-President

Secretary General/-/ signature/-/ signature/-/ signature

Ole Hyldegaard

Jean-Eric BlatteauPeter Germonpre

President

Vice-President

Honorary Secretary

On behalf of the EUBS:

1Mathieu D, Marroni A, Kot J. Tenth European Consensus Conference on Hyperbaric Medicine: recommendations for accepted and nonaccepted clinical indications and practice of hyperbaric oxygen treatment. Diving Hyperb Med. 2017 Mar;47(1):24-32.
doi: 10.28920/dhm47.1.24-32. Erratum in: Diving Hyperb Med. 2017 Jun;47(2):131-132. PMID: 28357821; PMCID: PMC6147240.

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