Hyperbaric oxygen therapy for stroke: a systematic review of the evidence

Abstract

Objective: To identify the benefits and harms of using hyperbaric oxygen therapy to treat acute or subacute stroke or the chronic effects of a stroke. We aimed to identify any gaps in the evidence to provide guidance for future research. Design: A systematic review of the evidence. Search strategy: We searched MEDLINE, EMBASE, the Cochrane Library, HealthSTAR, CINAHL, MANTIS, bibliographic databases from professional societies and hyperbaric oxygen therapy practitioners, and reference lists. Databases were searched from inception to December 2003. Inclusion criteria: Studies: Controlled clinical trials and observational studies published in English. Participants: Patients with ischaemic stroke in any inpatient or outpatient setting. Outcomes: Mortality, functional health outcomes and adverse events. Data collection and analysis: Using predetermined criteria, two reviewers assessed each study for inclusion, and abstracted data about study design, population, interventions, and outcomes. We assigned an overall quality rating (good, fair, or poor) based on internal validity. Results: We identified only four randomized controlled trials and one controlled clinical trial. The best evidence shows no benefit to hyperbaric oxygen therapy in patients with stroke, but because the stage of patients enrolled (acute, subacute, or chronic), the documentation of type and severity of stroke, and the dosage of hyperbaric oxygen therapy given varied considerably, the generalizability of these results is limited. We identified 17 observational studies; all were poor quality. Conclusions: The overall evidence is insufficient to determine the effectiveness of hyperbaric oxygen therapy in any subgroup of stroke patients. To determine if hyperbaric oxygen therapy for stroke provides any benefit and that these outweigh potential harms, good quality studies are needed.