ECHM and UHMS Release Recommendation and Guidelines for Proper Use of Hyperbaric Oxygen Chambers in COVID-19 Cases

Since the starting of the coronavirus pandemic, research is being conducted to analyze if HBOT therapy is a possible treatment for critical COVID-19 patients. In multiple cases, the research has given a positive outcome, due to which doctors in Europe have started utilizing hyperbaric oxygen chambers to improve the symptoms of critically ill COVID-19 patients.

However, most of these sessions are conducted in multi-place hyperbaric oxygen chambers. Even after a thorough cleaning and regular disinfection measures, the oxygen hoods and breathing masks utilized by patients in a restricted place increases the chances of cross-infection. Considering the medical condition and the age of the patient, healthcare centers must reevaluate the usage HBOT chamber through guidelines given by UHMS and ECHM. This also includes checking the feasibility of HBOT, the urgency of the treatment in patients, and the limit of sessions needed by a patient.

Based on these factors, the ECHM and UHMS have given some important guidelines for the use of hyperbaric oxygen chambers. Below we have discussed these guidelines in detail.

Recommendations by EHCM For Hyperbaric Oxygen Chamber Usage

Below are the guidelines offered by the EHCM for the use of hyperbaric oxygen chambers in the case of non-COVID cases and in the case of COVID-19 cases.

In Non-COVID Cases

1. Do not allow patients with suspected or confirmed infection or patients who suffer from fever in the HBOT chamber or center.
2. Reduce the number of patients who can receive HBOT therapy in the chamber at one time. This can also mean allowing only one patient per chamber along with the medical attendant.
3. To secure the patient from reaching or breathing ambient air, utilize masks and hoods as soon as possible. This means till the decompression ends.
4. It is suggested to eliminate or at least limit the air breaks which involve breathing the internal air in the hyperbaric oxygen chamber.
5. Medical attendants should utilize proper protective gear such as masks throughout the session. The medical attendant can also stay in the lock by creating a closed hatch in the compartment.
6. After every hyperbaric session, discard or dispose of breathing systems, without storing any part in the hyperbaric oxygen chamber.
7. Disinfect and properly clean every hyperbaric oxygen chamber with proper cleaning material to kill pathogens present inside the chamber. The atmosphere should be cleaned using UV systems.

In COVID-19 Cases

8. For patients who are suspects or potential cases of COVID-19, a medical attendant should be present in the chamber. However, the attendant should wear isolating garments, masks, and other gear as per the requirements. It is necessary to use HBOT compatible gear to avoid the risk of fire. It is also necessary to check the fire-fighting unit, which should also contain manual extinguishers. The fractional oxygen amount should be 21% inside the chamber.
9. If the HBOT patient is conscious, he or she should wear a mask until shifted to HBOT hood or mask. Once replaced, the personal mask should be discarded. After concluding the HBOT session, the patient should use a new personal mask and other safety gear.
10. To reduce the cerebral toxicity risk, the pressure in the hyperbaric oxygen chamber can be reduced to 2.0-2.2 ATA.

Additional Guidelines by UHMS

The following guidelines are given by UHMS. We will discuss only those UHMS guidelines, which are not discussed above. This means that all the above guidelines are also included in the UHMS release in a different format.

1. Create a sanitization station for allowing everyone to sanitize and wash hands regularly.
2. If possible, clinicians should ask their patients to wash hands and put on masks before entering to reduce infection spread.
3. Use of N95 or BIBS masks throughout the hyperbaric treatment to avoid the spread of infection inside the chamber.
4. Avoid storing the patient’s mask and gear in the locker. Destroy or discard the mask and other such infectious material immediately.
5. Optimize patient isolation with standard precautions for airborne diseases. This should be achieved through surgical masks or other equipment. However, if the concerned patient is intubated, use a HEPA filter between the ventilator and endotracheal tube. Take into account the risk of improper ventilation and an increase in CO₂
6. Limit exposure on the patient-to-patient level to avoid the spread of the virus.
7. Wash and clean hands before entering the chamber and after leaving the chamber.
8. Utilize disinfectant which is appropriate for use inside the hyperbaric oxygen chamber.

Conclusion

According to the ECHM and UHMS, using the HBOT treatment for COVID-19 patients should be achieved only after carefully evaluating the side-effects and necessity of the treatment in any patient. If every consideration indicates the use of hyperbaric oxygen chambers, then only move in the direction of HBOT. Patients who have HBOT home units should avoid receiving HBOT treatment for coronavirus disease at home.