University of Iowa Hospitals and Clinics researchers are using hyperbaric oxygen chambers to provide therapy for patients with severe traumatic brain injuries, hoping to improve patient outcomes.

Principal Investigator and UI Professor of Emergency Medicine, Anesthesia and Epidemiology Vice Chair for Research Nick Mohr said the Hyperbaric Oxygen Brain Injury Treatment Trial is a study funded by the National Institutes of Health which attempts to answer the question of how hyperbaric oxygen therapy improves the recovery of patients with severe traumatic brain injury.

The study uses hyperbaric treatment chambers that deliver high-pressure oxygen to the patient’s brain, he said.

Mohr said this therapy isn’t new and has been used for a number of different diseases at UIHC, including carbon monoxide poisoning. The team hopes to see similar results in severe traumatic brain injury patients, he said.

“The hope is that after somebody sustains a severe brain injury that the hyperbaric oxygen therapy helps to reduce the secondary damage from swelling and cell death in the brain,” Mohr said. “Our study is really trying to understand if people who survive a really severe injury, who are treated with hyperbaric oxygen therapy, can be more independent and can have more functional survival after their recovery.”

Some of the most common ways that people sustain a traumatic brain injury are from hitting their head during severe car crashes, motorcycle crashes, and some falls, Mohr said.

According to the Centers for Disease Control, traumatic brain injury is a major cause of death and disability in the U.S. In 2014, about 2.87 million TBI-related emergency department visits, hospitalizations, and deaths occurred in the U.S., including 837,000 cases among children.

The outcomes from traumatic brain injury are variable based on characteristics of the injury and age, Mohr said. He said the hyperbaric oxygen treatment attempts to target swelling in the brain that can lead to more damage when untreated.

One of the current ways to treat traumatic brain injuries is to stop bleeding in the brain, Mohr said. For people enrolled in this study, they might need aggressive medical treatments, and some are on life support, he said.

He added that after staying in the hospital, many patients go to rehabilitation facilities to recover.

“Despite all of those treatments that we have, the outcomes from traumatic brain injury are still really poor,” Mohr said. “That’s really one of the important reasons that we’re doing this research is to try to come up with a therapy that gives people a better recovery.”

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The study started on June 25, 2018 but made a change in the past few months to the consent process, called Exception from Informed Consent. This process, permitted under the Food and Drug Administration and National Institutes of Health regulations, allows for the enrollment of people quickly without the consent of a family member.

Mohr said this change will allow them to enroll more people and make more patients eligible. UI Research Coordinator in the Department of Emergency Medicine Cathy Fairfield said the team will also continue to use their traditional technique of speaking with the families.

“We approach families after they come in and we’ve identified that their loved one would fit the trial,” Fairfield said. “Then we have a conversation with the families about this study, and answer their questions.”

There are 55 patients enrolled in the trial across the 13 sites in the U.S. and Canada. Fairfield said the trial hopes to enroll 200 participants.

This trial is important in the research to improve traumatic brain injury patient outcomes, Clinical Assistant Professor of Anesthesia Archit Sharma said.

“This is an important cause, because there’s not much that is available for treating traumatic brain injury and that makes it a real special thing to start working on and try to provide any kind of information,” Sharma said. “We have formed this study with a lot of care to make sure that we provide the very best care to the patients during all courses of their stay here.”

While the trial is in the early stages, Mohr said there’s been promising data so far that hyperbaric oxygen therapy can change the function of the cells in the brain.

“The main outcome of the study is neurologic recovery three months later. We’re following these patients for months after their treatment, and what we’re hoping to see is that people will have more complete neurologic recovery with the ability to live independently,” Mohr said. “We’re really looking for these outcomes that are very centered on the experience that our patients have and how that allows them to live independently after their injury.”

Mohr said he is excited to be one of the leaders studying this new therapy and hopes it will improve patient outcomes.

“This is a really important study because it changes the way that we think about traumatic brain injury,” Mohr said. “We’re excited to be participating here at the University of Iowa, and we think it’s really important that people in our community and in Iowa, are able to participate in practice changing research like this.”