Safety and Efficacy of Hyperbaric Oxygen for ARDS in Patients With COVID-19

NCT ID: NCT04327505

Last Updated: 2023-01-09

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

TERMINATED

Clinical Phase

PHASE2/PHASE3

Total Enrollment

34 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-06-03

Study Completion Date

2022-12-01

Brief Summary

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COVID-19 may cause severe pneumonitis that require ventilatory support in some patients, the ICU mortality is as high as 62%. Hospitals do not have enough ICU beds to handle the demand and to date there is no effective cure.

We explore a treatment administered in a randomized clinical trial that could prevent ICU admission and reduce mortality.

The overall hypothesis to be evaluated is that HBO reduce mortality, increase hypoxia tolerance and prevent organ failure in patients with COVID19 pneumonitis by attenuating the inflammatory response.

Detailed Description

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Main objective: To evaluate if HBO reduce the number of ICU admissions compared to Best practice for COVID-19

Secondary objectives:

Main secondary objectives:

To evaluate if HBO:

* reduces mortality in severe cases of COVID-19.
* reduces morbidity associated with COVID-19.
* reduce the load on ICU resources in COVID-19.
* mitigate the inflammatory reaction in COVID-19.

Other secondary objectives (in selection):

To evaluate if HBO is safe for SARS-CoV-2 positive patients and staff.

Study design: Randomized, controlled, phase II, open label, multicentre

Study population: Adult patients with SARS-CoV-2 infection, with at least two risk factor for increased mortality, likely to develop ARDS criteria and need intubation within 7 days of admission to hospital.

Number of subjects: 200 (20+180)

Investigational product: Hyperbaric oxygen (HBO) compared with best practice treatment HBO: HBO 1.6-2.4 ATA for 30-60 min, maximum 5 treatments first 7 days Control: Best practice treatment for COVID-19

Conditions

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SARS (Severe Acute Respiratory Syndrome) Cytokine Storm ARDS, Human COVID-19 Sars-CoV2 Acute Respiratory Failure

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Randomized controlled, open label, multi-centre clinical trial
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Hyperbaric oxygen

Hyperbaric oxygen 1,6-2.4 Bar for 30-60 minutes (compression/decompression time, according to local routines) in addition to best practice

Group Type EXPERIMENTAL

Hyperbaric oxygen

Intervention Type DRUG

1.6- 2.4 ATA, 30-60 min (excluding compression/recompression)

Control

Best practice

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Hyperbaric oxygen

1.6- 2.4 ATA, 30-60 min (excluding compression/recompression)

Intervention Type DRUG

Other Intervention Names

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HBO

Eligibility Criteria

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Inclusion Criteria

1. Aged 18-90 years
2. PaO2/FiO2 (PFI) below 200 mmHg (26.7 kPa)
3. Suspected or verified SARS-CoV-2 infection
4. At least two risk factors for increased morbidity/mortality

* Age above 50 years
* Hypertension
* Cardiovascular disease
* Diabetes or pre-diabetes
* Active or cured cancer
* Asthma/COPD
* Smoking
* D-Dimer \> 1.0 mg/L
* Auto-immune disease
5. Documented informed consent according to ICH-GCP and national regulations

8. Mental inability, reluctance or language difficulties that result in difficulty understanding the meaning of study participation

Exclusion Criteria

1. ARDS/pneumonia caused by other viral infections (positive for other virus)
2. ARDS/pneumonia caused by other non-viral infections or trauma
3. Known pregnancy or positive pregnancy test in women of childbearing age
4. Patients with previous lung fibrosis more than 10%
5. CT- or Spirometry-verified severe COPD with Emphysema
6. Contraindication for HBO according to local guidelines
Minimum Eligible Age

18 Years

Maximum Eligible Age

90 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Karolinska Trial Alliance

INDUSTRY

Sponsor Role collaborator

University of California, San Diego

OTHER

Sponsor Role collaborator

Blekinge County Council Hospital

OTHER

Sponsor Role collaborator

JK Biostatistics AB

UNKNOWN

Sponsor Role collaborator

The Swedish Research Council

OTHER_GOV

Sponsor Role collaborator

University of Regensburg

OTHER

Sponsor Role collaborator

Karolinska Institutet

OTHER

Sponsor Role lead

Responsible Party

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Anders Kjellberg, MD

ICU Consultant/PhD student

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Anders Kjellberg, MD

Role: PRINCIPAL_INVESTIGATOR

Karolinska Institutet

Peter Lindholm, MD, PhD

Role: STUDY_CHAIR

Karolinska Institutet

Kenny Rodriguez-Wallberg, MD, PhD

Role: STUDY_CHAIR

Karolinska Institutet

Locations

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Krankenhaus St. Joesf

Regensburg, , Germany

Site Status

Blekingesjukhuset

Karlskrona, Blekinge County, Sweden

Site Status

Karolinska University Hospital

Stockholm, , Sweden

Site Status

Countries

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Germany Sweden

References

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Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, Xiang J, Wang Y, Song B, Gu X, Guan L, Wei Y, Li H, Wu X, Xu J, Tu S, Zhang Y, Chen H, Cao B. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020 Mar 28;395(10229):1054-1062. doi: 10.1016/S0140-6736(20)30566-3. Epub 2020 Mar 11.

Reference Type BACKGROUND
PMID: 32171076 (View on PubMed)

Oscarsson N, Muller B, Rosen A, Lodding P, Molne J, Giglio D, Hjelle KM, Vaagbo G, Hyldegaard O, Vangedal M, Salling L, Kjellberg A, Lind F, Ettala O, Arola O, Seeman-Lodding H. Radiation-induced cystitis treated with hyperbaric oxygen therapy (RICH-ART): a randomised, controlled, phase 2-3 trial. Lancet Oncol. 2019 Nov;20(11):1602-1614. doi: 10.1016/S1470-2045(19)30494-2. Epub 2019 Sep 16.

Reference Type BACKGROUND
PMID: 31537473 (View on PubMed)

Thibodeaux K, Speyrer M, Raza A, Yaakov R, Serena TE. Hyperbaric oxygen therapy in preventing mechanical ventilation in COVID-19 patients: a retrospective case series. J Wound Care. 2020 May 1;29(Sup5a):S4-S8. doi: 10.12968/jowc.2020.29.Sup5a.S4.

Reference Type BACKGROUND
PMID: 32412891 (View on PubMed)

Gorenstein SA, Castellano ML, Slone ES, Gillette B, Liu H, Alsamarraie C, Jacobson AM, Wall SP, Adhikari S, Swartz JL, McMullen JJS, Osorio M, Koziatek CA, Lee DC. Hyperbaric oxygen therapy for COVID-19 patients with respiratory distress: treated cases versus propensity-matched controls. Undersea Hyperb Med. 2020 Third Quarter;47(3):405-413. doi: 10.22462/01.03.2020.1.

Reference Type BACKGROUND
PMID: 32931666 (View on PubMed)

Kjellberg A, De Maio A, Lindholm P. Can hyperbaric oxygen safely serve as an anti-inflammatory treatment for COVID-19? Med Hypotheses. 2020 Nov;144:110224. doi: 10.1016/j.mehy.2020.110224. Epub 2020 Aug 30.

Reference Type BACKGROUND
PMID: 33254531 (View on PubMed)

Kjellberg A, Douglas J, Hassler A, Al-Ezerjawi S, Bostrom E, Abdel-Halim L, Liwenborg L, Hetting E, Jonasdottir Njastad AD, Kowalski J, Catrina SB, Rodriguez-Wallberg KA, Lindholm P. COVID-19-Induced Acute Respiratory Distress Syndrome Treated with Hyperbaric Oxygen: Interim Safety Report from a Randomized Clinical Trial (COVID-19-HBO). J Clin Med. 2023 Jul 24;12(14):4850. doi: 10.3390/jcm12144850.

Reference Type DERIVED
PMID: 37510965 (View on PubMed)

Kjellberg A, Douglas J, Pawlik MT, Kraus M, Oscarsson N, Zheng X, Bergman P, Franberg O, Kowalski JH, Nyren SP, Silvanius M, Skold M, Catrina SB, Rodriguez-Wallberg KA, Lindholm P. Randomised, controlled, open label, multicentre clinical trial to explore safety and efficacy of hyperbaric oxygen for preventing ICU admission, morbidity and mortality in adult patients with COVID-19. BMJ Open. 2021 Jul 5;11(7):e046738. doi: 10.1136/bmjopen-2020-046738.

Reference Type DERIVED
PMID: 34226219 (View on PubMed)

Related Links

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https://ki.se/en/fyfa/hyperbaric-medicine

Hyperbaric medicine research group, Karolinska Institutet

http://www.eubs.org/?p=1074

COVID-19 EUBS-ECHM position statement on HBOT

Other Identifiers

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2020-001349-37

Identifier Type: EUDRACT_NUMBER

Identifier Source: secondary_id

K-1199/2020

Identifier Type: REGISTRY

Identifier Source: secondary_id

COVID-19-HBO

Identifier Type: -

Identifier Source: org_study_id

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