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Hyperbaric Oxygen Therapy as a Generic Drug for Reperfusion Injury

Dr. Paul G. Harch discusses hyperbaric oxygen therapy (HBOT) as a generic drug for reperfusion injury, after presentation to the 5th European Federation of Neurological Societies Meeting in Copenhagen,Denmark, 2000

Paul G. Harch and Richard A. Neubauer

 An entry from K.K. Jain's Textbook Of Hyperbaric Medicine

Hyperbaric oxygen therapy has been used in a number of conditions characterized by global ischemia (as opposed to focal ischemia of stroke), and anoxia, and leading to impairment of consciousness.

Tommy Tarlton Races for a Cause to Benefit Wounded Warriors


Please view John Salcedo's movie Brain Storm "Thunder Bowl" at  RealShowInt.Com

Join the Cause this Spring 2011

VTX Wounded Worrier Bike Run


 California VTX Riders Honor a Wounded Warrior at the 8th Annual Wounded Warrior Run

Please join us on this day as we honor this years Wounded Warrior. Our event is a fundraiser and 100% of funds collected will be donated to our Warrior. Join us for lunch, drinks, live music and dancing, visiting with old friends and making new ones. It's for the Warrior so please join us.

Our day starts at Loma Linda VA Hospital in Riverside, CA to have breakfast with our Veterans. Then we move to the junction of Hwy 138 and Interstate 15 to line up for the ride up the hill at 10:00am, we will stop at Silverwood lake to take a group picture then on to the BBQ!!

There will be T-shirts for sale and well some very good food! All proceeds are donated to our Wounded Warrior. You do not need a motorcycle to join us, and this is a family event!! See you there!!

IHMA - Report from Inside the Beltway, Washington, D.C.

Compressed air began being used to treat Caisson's disease and diving injuries over 120 years ago. Back in 1936, 74 years ago, Behnke published the diving tables using oxygen instead of just compressed air to treat diving injuries. Oxygen diving tables were not adopted by the U.S. Navy until 1968!

Unfortunately, Hyperbaric oxygen therapy has never been taught in U.S. medical schools, and there are only a few Hyperbaric medicine fellowships. Until recently, in 2003 when the IHMA petitioned Medicare and got diabetic foot wounds approved because it prevents 75% of all amputations, Hyperbaric medicine was only available at about 500 locations. Now it is available at over 1,000 locations and increasing weekly. With it, continuing medical education is being pursued by physicians, and many more physicians today are aware of the benefits of saturating the body's tissues with oxygen. Thanks to Congressman Istook's efforts, Hyperbaric oxygen therapy is again receiving grants from the National Institutes of Health, and Dr. Stephen Thom has published some ground-breaking research as a result. The previous testimony to Congress, before Dr. Harch's in 2002, was in 1963. I assure you that no other medical specialty has taken so long to tell Congress what they are able to do.

Unfortunately, though DoD developed this medicine, it has not been fully implemented to the level of known benefit to patients. This is largely because everyone "thought" they were treating bubbles as the cause of decompression sickness, the primary indication. It turned out they were generally treating damage the bubbles cause, not just bubbles. That was not discovered until 1989. Many today still believe they are treating bubbles, and this misunderstanding has held back the science and acceptance of HBOT as a therapy for general application to the repair of underlying biological processes common to many conditions.

CRAO a Continuing Look at HBOT as a Treatment for this Vascular Event

We believe our experience with HBOT for CRAO justifies continuing its use as the treatment of choice. It is hoped that our experience will encourage more referrals in the favorable first eight hours. The intensive treatment regimen was satisfying to us, and we hope others find it equally effective in preserving vision.  HBOT is a logical treatment for central retinal artery occlusion.  This continuing study corroborates improvement of vision using HBOT when the occlusion is under 24 hours, and further study will be needed to determine effectiveness of treatment after a 24-hour period has elapsed.

Hyperbaric Oxygen Therapy in Central Retinal Artery Occlusion


By Paul G. Harch, M.D.
Clinical Associate Professor
LSU School of Medicine, New Orleans



Central Retinal Artery Occlusion (CRAO) is a painless, severe, usually sudden onset loss of vision in the eye that is due to occlusion of the central retinal artery. Visual loss is in the range of light perception to counting fingers in 90% of cases. In primates, if vision isn't restored within approximately 90-100 minutes, permanent injury to retinal cells occurs. In humans, however, the situation is more complicated and depends on retinal vascular anatomy. In patients with a cilioretinal artery that supplies part of the fovea, 10% of the population, 80% will have return of 20/50 vision. In the remainder of the population with CRAO, vision remains at the counting fingers to hand-motion level.

In the 1980s, the physician team at the JoEIIen Smith Hyperbaric Medicine Department in New Orleans, under the direction of Dr. Keith Van Meter, began to treat central retinal artery occlusion. The cases were referred by forward thinking retinal specialists who had read case reports of a small series of patients who had been treated with hyperbaric oxygen therapy. Eventually, we were referred every CRAO patient from a particular ophthalmology practice. Given the typically grim prognosis of these patients and the lack of substantive evidence that established a firm timeline beyond which HBOT would be ineffective, we treated every patient. We were able to achieve improvement in vision in the great majority of patients, despite delays to treatment beyond 12 hours. One of the key features of this treatment was an adaptive approach to dosing where we would decrease the HBOT dose from the traditional 2.4-2.8 ATA to as low as 1.5 ATA, as the patient plateaued at the higher pressures. In 2004, one of our hyperbaric fellows, Dr. Heather Murphy-Lavoie, reviewed our patient series and compared them to an age-matched control group from Charity Hospital, New Orleans. She presented the abstract at the 2004 UHMS meeting in Sydney, Australia. Based on this presentation, she was invited to submit an application to the UHMS HBOT Committee to add CRAO to the accepted indications list. That application was submitted and approved in 2008 with an American Heart Association Class lib level of evidence: "There is fair to good evidence to support its use with retrospective case series but no prospective randomized controlled trials. It is acceptable, safe, considered efficacious but lacks confirmation of efficacy by level 1 studies. There is no evidence of harm and consistently positive results. In addition, there are no alternative therapies with similar outcomes."¹

The importance of the CRAO HBOT Committee approval lies in the implications for the future of additional occlusive vascular indications. CRAO is a rare condition. The impact of HBOT on individual cases is substantial and justifies the application of HBOT for this condition. However, the impact on society is minimal. What is more important is the scientific argument for HBOT that is based on the pathophysiology of CRAO, which is a sudden complete occlusion of arterial blood supply to nervous tissue. Sudden arterial occlusion is nearly identical pathophysiologically to the accepted indication of traumatic interruption of peripheral arterial supply and the Medicare indication of acute peripheral arterial insufficiency. CRAO is the same pathophysiology in the retinal circulation. In all three of these conditions, there is a period of complete or near complete interruption of blood supply which is followed by a period of reperfusion injury as circulation is re-established either surgically or by recanalization. The peripheral arterial interruptions/insufficiencies are better described in lay terms as "acute traumatic stroke" or "acute stroke of the arm or leg" while CRAO then is an "acute stroke of the eye."

The analogy to "stroke" is important because HBOT is the use of greater than atmospheric pressure oxygen as a drug to treat basic disease processes. In all three of these conditions we are treating an underlying complete occlusion or interruption of blood supply to human tissue. Two of the tissues are outside the central nervous system and the third is in the central nervous system. The tissue and its location are somewhat irrelevant, but if we can now accept stroke of the eye based on Class lib evidence, it should expand our thinking to the broad range of pathophysiologically similar conditions characterized by gross cessation/interruption and then re-establishment of blood supply. Examples include hepatic artery occlusion (there are a number of references for HBOT treatment of this condition in the pediatric liver transplant literature), mesenteric artery occlusion, coronary artery occlusion, (acute myocardial infarction), the group of global ischemias (cardiac arrest, near-hanging, near-drowning), and of course, cerebral artery occlusion (stroke). Interestingly, HBOT in cerebral stroke is supported by over 35 animal and an equal number of human studies, some prospective and controlled, with the great majority at least meeting the Class lib or higher level of evidence. The following cases should stimulate your thinking of application of HBOT based on pathophysiology rather than diagnosis.


Reference List

1. Heather Murphy-Lavoie, Frank Butler and Catherine Hagan. Central Retinal Artery Occlusion. In: Gesell LB, Chair and Editor, Hyperbaric Oxygen Therapy Indications, 12th Edition. The Hyperbaric Oxygen Therapy Committee Report, Durham, NC: Undersea and Hyperbaric Medical Society, 2008. p.57-66.


HBOT in the Treatment of Chronic Traumatic Brain Injury:







The application of hyperbaric oxygen therapy (HBOT) to chronic traumatic brain injury (TBI) can be traced to clinical practice and research in South Florida and New Orleans, Louisiana. It is well known that the practice of HBOT in chronic neurological conditions was pioneered by the late Dr. Richard Neubauer in the 1970s. Beginning with a serendipitous finding of gratuitous neurological improvement in two multiple sclerosis patients undergoing HBOT for chronic bone infections, Dr. Neubauer began applying HBOT to patients with other neurological conditions, primarily stroke. In 1994, he published his first case of HBOT treatment of chronic TBI in the Southern Medical Journal.


Chad Rovira Acute TBI treated with HBOT

Comprehensive diabetes foot prevention and wound treatment at LSU interim public hospital


Comprehensive diabetes foot prevention and wound treatment at LSU interim public hospital

Paul G. Harch, M.D. Director
Myra Varnado, RN CWOCN, Clinical Manager
Wound Care and Hyperbaric Medicine Department

Diabetes foot wounds are an enormous health care problem. Every year 2% of the greater than 18 million diagnosed diabetes patients in the United States develop a foot ulcer. For those diabetes patients with peripheral neuropathy, 5 to 7.5% will develop a foot ulcer each year. In 2006, 65,700 lower extremity amputations were performed among people with diabetes. The personal loss and disability is substantial and is accompanied by significant health care costs. Diabetes foot ulcers result in more hospitalizations than any other complication of diabetes. In 1999 the cost of treating a foot ulcer over two years was $28,000.

LSU Diabetes Alert DayThe greatest personal risk and impact on health care costs, however, is the propensity of diabetes foot wounds to result in extremity amputations. Every year 12-24% of diabetes foot wounds result in amputation; this is over 60% of all non-traumatic amputations in the U.S. According to the CDC, diabetes related neuropathy with wounds has a relapse rate of 66% over 5 years, and 12% of people with wounds progress to amputation. The cost of an amputation exceeds $45,000, but puts the diabetes patient at risk for foot wounds on the opposite leg and eventual bilateral amputation. Fortunately, a substantial portion of these amputations are preventable. Prevention of lower extremity amputation is the primary goal of the LSU IPH Wound Care and Hyperbaric Medicine Department.


HBOT Treatment eyed for TBI/PTSD Traumatic Brain Disorder caused by Injury to Head and Post-Traumatic Stress Syndrome Symptoms

Dr. Paul Harch of New Orleans briefed the committee about his use of Hyperbaric Oxygen chambers to treat TBI and PTS, commonly regarded as the signature wounds of the war on terrorism.

Harch has used hyperbaric oxygen treatments for dozens of U.S. veterans who suffered injuries to the head resulting in TBI and who have developed post traumatic stress disorder PTSD. He recently finished up a study on 15 patients who showed improvements in several physical and mental tests after a series of Hyperbaric Oxygen therapy (HBOT) treatments, which involves patients breathing 100 percent oxygen inside a pressurized chamber.

NC Mom Wins HBOT Treatment for Autism

A blind mother of three autistic boys taking on the state of North Carolina and winning. When people learn of the "dirty pool" and dishonesty in the testimony of the state's experts they will be even more amazed. A debt of thanks is due to this judge. What a remarkable lady; willing to disregard ugly defense testimony and honor the reports of your treating doctor and the power of SPECT brain imaging. The evidence was so convincing that they didn't even attempt an appeal.

Congratulations to you, Dr. Harch.


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