300 Section - Effect of hyperbaric oxygen therapy on outcomes in delayed cerebral ischemia post aneurysmal subarachnoid hemorrhage

Aneurysmal subarachnoid hemorrhage (aSAH) accounts for 85% of spontaneous SAH cases leading to significant morbidity. Delayed cerebral ischemia (DCI), a complication of SAH worsens functional outcomes. This study evaluated the effect of hyperbaric oxygen therapy (HBOT) as an adjuvant to conventional treatment in DCI.

Design:

In this prospective non-randomized clinical trial, 30 patients with DCI post- endovascular coiling for aSAH were allocated to HBOT and control groups based on informed consent. Modified Rankin Scale (mRS), Disability Rating Scale (DRS), Stroke Specific Quality of Life scale (SS-QoL), and Modified Ashworth Scale (MAS) scores were assessed at baseline after coiling and at 1, 3, and 6 months. In the HBOT group, CT Hounsfield units were measured before and after the completion of HBOT sessions.

Results:

Sixteen patients received HBOT while fourteen were controls. The HBOT group showed greater improvement from baseline in mRS and SS-QoL scales across all follow-ups. DRS improvement also favored HBOT at 1 and 3 months, though differences were not statistically significant. Linear mixed-effects regression showed statistically significant improvement in mRS scores in the HBOT group at 3 months (p=0.034). mRS outcomes showed a moderate effect size at 3 months and 6 months. All patients except for one from the HBOT group, and all patients from the control group reported a return to normal tone on MAS at 6-months follow-up. The difference in means of CT Hounsfield units before and after the intervention was 2.46 with a standard deviation of 6.44 (p=0.16).

Conclusion:

HBOT as an adjunct to conventional treatment in DCI patients may accelerate functional recovery, with significant improvement at 3 months and moderate effect size at 3 and 6 months in mRS scores suggesting a clinically meaningful difference.