Hyperbaric oxygen therapy for COVID-19 patients with respiratory distress: treated cases versus propensity-matched controls
Authors:   Division of Wound Care, Department of Surgery, NYU Winthrop Hospital, New York, NY, U.S., Gorenstein, Scott A ,   NYU Long Island School of Medicine, New York, NY, U.S., Castellano Michael L ,   Division of Wound Care, Department of Surgery, NYU Winthrop Hospital, New York, NY, U.S.,   NYU Long Island School of Medicine, New York, NY, U.S., Slone Eric S ,   Division of Wound Care, Department of Surgery, NYU Winthrop Hospital, New York, NY, U.S.,   NYU Long Island School of Medicine, New York, NY, U.S., Gillette Brian ,   Division of Wound Care, Department of Surgery, NYU Winthrop Hospital, New York, NY, U.S.,   NYU Long Island School of Medicine, New York, NY, U.S., Liu Helen ,   Division of Wound Care, Department of Surgery, NYU Winthrop Hospital, New York, NY, U.S.,   NYU Long Island School of Medicine, New York, NY, U.S., Alsamarraie Cindy ,   Division of Wound Care, Department of Surgery, NYU Winthrop Hospital, New York, NY, U.S.,   NYU Long Island School of Medicine, New York, NY, U.S., Jacobson Alan M. ,   NYU Long Island School of Medicine, New York, NY, U.S.,   Foundations of Medicine Department, NYU Winthrop Hospital, New York, NY, U.S., Wall Stephen P ,   Department of Emergency Medicine, NYU Grossman School of Medicine, New York, NY, U.S.,   Department of Population Health, NYU Grossman School of Medicine, New York, NY, U.S., Adhikari Samrachana ,   Department of Population Health, NYU Grossman School of Medicine, New York, NY, U.S., Swartz Jordan L ,   Department of Emergency Medicine, NYU Grossman School of Medicine, New York, NY, U.S., McMullen Jenica JS ,   Department of Emergency Medicine, NYU Grossman School of Medicine, New York, NY, U.S., Osorio Marcela ,   Department of Emergency Medicine, NYU Grossman School of Medicine, New York, NY, U.S., Koziatek Christain A ,   Department of Emergency Medicine, NYU Grossman School of Medicine, New York, NY, U.S., Lee David C ,   Department of Emergency Medicine, NYU Grossman School of Medicine, New York, NY, U.S.,   Department of Population Health, NYU Grossman School of Medicine, New York, NY, U.S.
Published: December 2020

Objective: Given the high mortality and prolonged duration of mechanical ventilation of COVID-19 patients, we evaluated the safety and efficacy of hyperbaric oxygen for COVID-19 patients with respiratory distress. Methods: This is a single-center clinical trial of COVID-19 patients at NYU Winthrop Hospital from March 31 to April 28, 2020. Patients in this trial received hyperbaric oxygen therapy at 2.0 atmospheres of pressure in monoplace hyperbaric chambers for 90 minutes daily for a maximum of five total treatments. Controls were identified using propensity score matching among COVID-19 patients admitted during the same time period. Using competing-risks survival regression, we analyzed our primary outcome of inpatient mortality and secondary outcome of mechanical ventilation. Results: We treated 20 COVID-19 patients with hyperbaric oxygen. Ages ranged from 30 to 79 years with an oxygen requirement ranging from 2 to 15 liters on hospital days 0 to 14. Of these 20 patients, two (10%) were intubated and died, and none remain hospitalized. Among 60 propensity-matched controls based on age, sex, body mass index, coronary artery disease, troponin, D-dimer, hospital day, and oxygen requirement, 18 (30%) were intubated, 13 (22%) have died, and three (5%) remain hospitalized (with one still requiring mechanical ventilation). Assuming no further deaths among controls, we estimate that the adjusted subdistribution hazard ratios were 0.37 for inpatient mortality (p=0.14) and 0.26 for mechanical ventilation (p=0.046). Conclusions: Though limited by its study design, our results demonstrate the safety of hyperbaric oxygen among COVID-19 patients and strongly suggests the need for a well-designed, multicenter randomized control trial.