Written by Jacob Altholz
Spoon Feed
Hyperbaric oxygen is a seldom-used but effective adjunct when specific indications are met. Here’s what you need to know.
No pressure, we’ve compressed it for you
This review article sought to lay out the basic physiology and indications for hyperbaric oxygen therapy that we are most likely to encounter. Specific conditions and situations in which hyperbaric should be considered include the following:
- Decompression sickness: All cases
- Arterial gas embolism: All cases
- Central retinal artery occlusion: After definitive diagnosis
- Carbon monoxide (CO): Severe cases (LOC or organ dysfunction), pediatrics, or pregnancy
- Crush Injuries: Severe cases and appropriate surgical capabilities also available
- Necrotizing soft tissue infection: After antimicrobial treatment and debridement
- Symptomatic anemia: When transfusion is contraindicated
The article makes several other key points:
- There is inconsistent evidence for indications in CO exposure.
- Treatment of decompression sickness and arterial gas embolisms largely works by dissolving the gas rather than pressurizing it to be smaller in volume.
- Poison control can be a helpful resource to locate the nearest hyperbaric chamber.
- The most serious contraindications include air spaces not managed, if air transfer is needed (e.g. untreated pneumothorax).
How does this change my practice?
This article provides clear and concrete circumstances for when emergency physicians/clinicians should consult hyperbarics. As a toxicology fellow, the article is even more helpful in pointing out the controversy around certain indications (e.g. carbon monoxide) but still giving clear guidance about when a patient is a candidate regardless.
Source
Hyperbaric Oxygen Therapy: An Evidence-Based Primer for Emergency Physicians. J Emerg Med. 2025 Mar;70:35-44. doi: 10.1016/j.jemermed.2024.09.009. Epub 2024 Oct 9. PMID: 39939188
