Saturday • June 20, 2020 Featuring a distinguished array of speakers and abstract presenters CONTENTS SCHEDULE 2 ABSTRA CTS 3-6 WEBINAR Q&As for SPEAKERS DR. JOHN FELDMEIER: General discussion 7-8 DR. SANDRA WAINWRIGHT: Clinical course 8-10 of COVID-19 and the possible role of HBO2 DR. SCOTT GORENSTEIN: Safety concerns for the use 10-11 of HBO2 in COVID-19 patients MARCUS SPEYRER : Considerations for the use of HBO2 in COVID-19 patients 11-12 DR. MICHAEL BENNETT : Translation of research into practice 12-13 WEBINAR Q&As for ABSTRA CT PRESENTERS DR. PASQUALE LONGOBARDI 1 14-17 DR. ANDERS KJELLBERG 17-18 DR. KERRY THIBODEAUX 18-19 DR. DAVID LEE 20-23 AFTERNOON Q&AS (with all faculty on) 23-24 DR. JOHN FELDMEIER: Synthesis of the data 25-27 FACULTY INFORMATION 27-31 Webinar: Evidence Review for HBO2 Treatment of COVID-19 Patients 1 _______________________________________________________________ _______________________________________________________________ SCHEDULE 11:00 11:05 INTRODUCTION – Nicholas Bird, MD 11:05 11:20 SESSION 1: Pathophysiology of COVID-19 Kialing Perez, MD An overview of the SARS-CoV-2 virus, its transmission, and how it acts on the body. 11:20 11:25 Q & A 11:25 11:40 SESSION 2: Clinical course of COVID-19 and the possible role of HBO2 Sandra Wainwright, MD Describes the clinical course of COVID-19 from asymptomatic patients through ventilated patients, identifying any opportunities for intervention using HBO2. Will summarize the published clinical experience treating COVID-19 patients with HBO2. 11:40 11:45 Q & A 11:45 12:00 SESSION 3: Safety concerns for the use of HBO2 in COVID-19 patients Scott Gorenstein, MD Discusses potential hazards to COVID-19 patients including: pulmonary oxygen toxicity; sick patients leaving ICU to go to HBO2 department; pulmonary barotrauma. 12:00 12:05 Q & A 12:05 12:20 SESSION 4: Considerations for use of HBO2 in COVID-19 patients Marcus Speyrer, CHT Discusses operational considerations for facilities that intend to treat COVID-19 patients including: infection control in the hyperbaric chamber; staff education; adaptation of emergency procedures. 12:20 12:25 Q & A 12:25 12:40 SESSION 5: Translation of research into practice Michael Bennett, MD Discusses the balance between compassionate use of HBO2 versus the need for I RB-approved, evidence-based research including strategies to translate limited evidence into clinical practice. 12:40 12:45 Q & A 12:45 13:15 Additional Q & A 13:15 13:45 Break 13:45 16:00 Session 6: Abstract papers 15:25 16:00 Q & A 16:00 17:00 Session 7: Synthesis of the data John Feldmeier, DO Synthesizes the presented data into a cohesive document with three general goals: • What questions have we answered? • What questions still need to be answered? • What elements of study design should be incorporated in future studies? Moderators: Jay Buckey, MD: Nicole Harlan, MD; Andrew Melnyczenko, CHT 2 Webinar: Evidence Review for HBO2 Treatment of COVID-19 Patients ______________________________________________________________________________________________________________________________________________________ Evidence Review for HBO2 Treatment of COVID-19 Webinar: Abstracts ______________________________________________________________________________________________________________________________________________________ Effects of volatile gaseous compounds induced by hyperbaric oxygen, in counteracting the SARS-CoV-2 virus in asymptomatic patients and SARS-CoV-2-positive patients with mild symptoms Longobardi P 1, Hoxha K 1, Lanza F 2, Milandri M 2, Perreca F 1, Pinton P 3, Poletti G 2, Rubini M 3, Sambri V 2, Tajana G 4, Vezzani G 5, Pelaia P 6 1 Centro Iperbarico (Hyperbaric Center) Ravenna; 2 Romagna AUSL (Local Public Health Unit) 3 University of Ferrara; 4 Full Professor of Histology and Embryology 5 Honorary President of the Association of Patients Treated in Hyperbarism (As.Pa.T.I.) 6 Full professor of Anesthesia, Intensive Care and Intensive Care Presenting Author: Pasquale Longobardi, MD – [email protected] Hyperbaric oxygen (HBO2) therapy will be provided at glycoprotein (S) on the virus necessary to penetrate human cells. Centro Iperbarico in Ravenna, Italy, to patients as an adjunct Furthermore, in the early stages of virus replication, NO reduces to standard therapy for a cohort of 20 SARS-CoV-2-positive the reproduction of the genetic structure (viral RNA), altering patients. These are asymptomatic patients or patients with mild proteins (cysteine proteases) encoded in the Orf1a genetic site of symptoms who have nitric oxide synthase (NOS)genetic poly- the SARS-CoV-1 virus, and supposedly it will act the same way morphism and two or more comorbidities highly related to on SARS-CoV-2. the reduced NO synthesis and the mortality rate in COVID-19. HBO2 upregulates the hypoxia-inducible factor HIF (also In Italy the median age of patients who died from COVID-19 induced by oxidative stress), which promotes the expression of is 20 years older than asymptomatic positive patients. In addition, human antiviral peptides: defensins and cathelicidins effective to 82% of deceased patients have concomitant diseases strongly block the coated, positive-sense single-stranded RNA virus (such correlated with NOS genetic polymorphism and reduced as SARS-CoV-2). synthesis of NO. The pilot study protocol includes five HBO2 sessions of HBO2 therapy significantly increases the production of volatile 76 minutes each, once a day, with control of the nasopharyngeal gas compounds (VOCs) such as nitric oxide (NO), reactive oxy- swab for SARS-CoV-2 after the third and fifth 2HBO sessions. gen species (ROS) and reactive nitrogen species (RNS), which in After the intervention portion of this study, a chart review will the laboratory has proven capable of inhibiting the replication of be performed to compare the outcomes of intervention patients SARS-CoV. NO acts by reducing the palmitoylation of the spike versus patients who received standard of care (quarantine). n ______________________________________________________________________________________________________________________________________________________ Sounding the alarm: An unexpected hyperbaric emergency during the COVID-19 pandemic Vidafar, MA Plainview Hospital, Plainview, New York Presenting Author: Michael A Vidafar, CHT – [email protected] Case description: The impact of increased hospital burden increased, such as in the case of hospitalized and critically ill due to COVID-19 extends even to outpatient “COVID-free” units patients during the COVID-19 pandemic. The author presents and hospital-based hyperbaric programs not treating COVID a case report outlining a recent high-pressure alarm experienced populations. While the majority of discussion concerning the and resolved at Plainview Hospital’s Division of Advanced impact of COVID-19 is correctly focused on patient outcomes Wound Healing and Hyperbaric Medicine. and the role of hyperbaric oxygen (HBO2) in treatment – as well Intervention: Chamber operations were halted until O2 pres- as staff/HBO2 patient safety in terms of infection control when/ sure was satisfactorily controlled by high-pressure power washing where COVID patients are receiving HBO2 treatment), there is of LOX vaporizers by engineering staff. a potential for an increased burden on bulk O2 delivery systems Outcome: Incoming O2 pressure was restored; staff gained that can impact hyperbaric programs. This includes monoplace greater understanding of LOX systems. and multiplace facilities and is a safety concern that is often not Discussion: The primary emphasis of this case is the im- frequently drilled or seen. Incidents can occur when oxygen portance of communication among hospital departments and demand from the bulk O2 delivery (LOX) system is greatly leadership, the utilization of those resources, and the importance of interdisciplinary problem-solving. n Webinar: Evidence Review for HBO2 Treatment of COVID-19 Patients 3 ______________________________________________________________________________________________________________________________________________________ Efficacy and safety of hyperbaric oxygen for patients with COVID-19; rationale and protocol of the randomized controlled trial COVID-19-HBO2 Kjellberg A, Rodriguez-Wallberg K, Lindholm P Dept. Physiology and Pharmacology, Karolinska Institutet, Biomedicum, Solnavägen 9, 171 65 Solna Presenting Author: Anders Kjellberg, MD – [email protected] Introduction: SARS-CoV-2 affects the innate immune Study design: Prospective randomized open label multictr. response and activates an inflammatory cascade. Patients with Study population: 200 adults with moderately severe risk factors such as diabetes and hypertension have increased risk COVID-19 admitted to hospital and who require oxygen and of severe disease with inflammation out of control. Hyperbaric have at least two risk factors for increased morbidity/mortality oxygen (HBO2) has proven anti-inflammatory effects. The overall Intervention: HBO2 1.6-2.4 ATA, 30-60 minutes, with a hypothesis to be evaluated is that HBO2 may reduce mortality, maximum five treatments within seven days increase hypoxia tolerance and prevent organ failure in patients Control: Best practice for COVID-19 pneumonitis with COVID-19 pneumonitis by reducing the inflammatory Primary endpoint: ICU admission response. The primary objective is to evaluate if HBO2 reduces Main secondary endpoints: 30-day mortality, time to the number of ICU admissions compared to best practice for