Oxygen Provides New Hope for Brain Injured Soldiers

In early December 2008, the Department of Defense with the Navy as lead agency sponsored a conference on the healing effects of 100 percent oxygen under pressure on brain-injured patients.  The procedure is called Hyperbaric Oxygen Therapy, or HBOT.   Though this conference generally went unnoticed in the national media, the importance of the developments discussed cannot be overstated.  

What underscores the significance of this conference is that Traumatic Brain Injury, or TBI, is the “signature” injury for those serving in Operation Iraqi Freedom and Operation Enduring Freedom (OIF/OEF), the conflicts in Iraq and Afghanistan.   The extensive use of improvised explosive devises (IED) by the enemy has resulted in a significant number of brain-injured combat veterans of OIF/OEF.  A study by the RAND Corporation released in April 2008 titled Invisible Wounds of War:  Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery puts the number of returning soldiers who could be suffering from mild to severe TBI as high as 320,000.  Recent application of HBOT has produced very promising results, giving real hope to those suffering from TBI.

The Department of Defense’s “Wounded, Ill and Injured” program has stressed ensuring the best medical treatment possible for service members returning from OIF/OEF. It has put a priority on assessing the efficacy of HBOT.  HBOT is an important initiative to provide the most effective treatment for soldiers suffering from brain injuries back to living normal lives, but there is another important consideration.  

Getting soldiers back on their feet and fit for duty with a treatment regimen that is a relatively inexpensive is good government.   The money that would have gone for more traditional and expensive treatments of the brain-injured now can be used to fund other medically urgent injuries and illnesses.  

So, what exactly is HBOT?  HBOT treatments are similar to the treatments given to treat victims of “the bends”, the condition divers sometimes suffer.  Patients are placed in a chamber filled with 100 percent oxygen at a positive pressure of one-and-a-half-times normal sea level atmospheric pressure, or what you would experience if you were SCUBA diving at a depth of around 16.5 feet.  The treatment involves up to 80 one-hour sessions administered in two blocks or phases over 120 days.  

The therapy is not new.  The HBOT regimen has been used for years in the treatment of deep-sea divers suffering from the bends, victims of carbon monoxide poisoning, and patients suffering from abscesses on the brain.  In fact, the federal government’s Food and Drug Administration (FDA) and Medicare have approved this therapy for the types of injuries mentioned above.  Other medical conditions for which HBOT has been used successfully include the treatment of tissue damage on diabetic patients’ feet.  The therapy has been shown to prevent 75 percent of amputations for such patients.

The obvious questions are, “Just how effective is HBOT in the treatment of TBI and is the science behind the treatment solid?”  Although the medical research on HBOT as a treatment for brain injuries resulting from explosions and traumatic blows to the head has not been subjected to the rigor of scientific methodologies, there is ample anecdotal evidence of the healing qualities of HBOT for TBI patients.  Dr. Paul Harch, MD, from Louisiana State University in New Orleans and one of the medical community’s leading experts and most experienced researchers in the use of HBOT for those diagnosed with TBI, has presented evidence of significant improvement.  

In an interview with Harch for this article, he explained that, “It is rare to find an unsuccessful outcome.  Of the patients treated with hyperbaric oxygen therapy, 90 percent have shown improvement a year out.”  Dr. Harch went on to point out that of patients identified for a pilot program of HBOT, the first three patients treated have shown a substantial recovery.   But, as Harch also made it clear that he has confidence that additional studies with larger sample groups will provide the necessary data to allay what lingering doubts there may be about HBOT as the treatment of choice for brain-injured patients.   

Finishing our interview, Harch emphasized, “… we are trying to get the military to appreciate that the time-honored principle in medicine of ‘the sooner the treatment the better’ is applicable to HBOT in acute traumatic brain injury.  The evidence is there that at the dose we are using in chronic TBI a few treatments within the first 72 hours after acute severe traumatic brain injury can have up to a 60 percent reduction in mortality.”

Proposals for completing a comprehensive study of the positive effects on TBI using HBOT would involve 100 patient subjects at a cost per individual of $25,000 or $2.5 million total.  The clinical trial would include brain imaging at selected universities or medical facilities, psychometric testing, data analysis, patient follow-up, and monitoring.   When compared with the $1.6 billion that the Congressional Budget Office has estimated that the current Traumatic Brain Injury Act of 2008 will cost taxpayers over the 2009 – 2013 time period, the cost of the HBOT trial is very small.  But, the results of this trial will have inestimable value for patients suffering from TBI and their families.

There is another clear benefit of achieving more rapid recovery to normal brain functioning in our wounded warfighters.   Seasoned troops are ready for duty in greater numbers, and military readiness is increased as a result.  The American Association for Health Freedom, a health and wellness advocacy group located in Arlington, Virginia, estimates that at the current civilian Medicare reimbursement rate the average one-time cost of treatment is $8,000 for 40 HBOT sessions and $16,000 for the entire regimen.  Considering that an infantry soldier costs roughly $20,000 to recruit; about $18,000 to put through basic training; and another $2,000 for essential equipment, like boots and body armor (a total of around $40,000), $16,000 to get a soldier fit and back on active duty doesn’t seem much to pay.  

Hyperbaric Oxygen Therapy may not be the silver bullet that achieves 100 percent recovery in every brain-injured soldier, but existing evidence of success and low risk of side effects speaks loudly that this treatment now needs to be offered as an option to our injured warfighters.   It is to the great credit of the outgoing Bush Administration and the Department of Defense that they are pursuing this important medical initiative.  Again, in the words of Navy Secretary Don Winter, “The goal is to move forward quickly in obtaining valid scientific support to safely establish clinical guidelines for the use (of) HBOT in the total treatment regimen for our wounded warriors suffering from TBI.”