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NCT02407028PHASE2Recruiting

Hyperbaric Oxygen Brain Injury Treatment Trial

Gaylan Rockswold

Start Date

6/25/2018

Completion Date

6/30/2029

Summary

The purpose of this innovative adaptive phase II trial design is to determine the optimal combination of hyperbaric oxygen treatment parameters that is most likely to demonstrate improvement in the outcome of severe TBI patients in a subsequent phase III trial.

Detailed Description

Preclinical and clinical investigations strongly indicate that hyperbaric oxygen (HBO2) is physiologically active in improving the destructive processes in severe Traumatic Brain Injury (TBI). However, prior to a definitive efficacy study, important information is required regarding optimizing the HBO2 treatment paradigm instituted in terms of pressure and whether NBH enhances the clinical effectiveness of the HBO2 treatment. Preclinical investigators working with TBI models have used pressures varying from 1.5 to 3.0 atmospheres absolute (ATA). Clinical investigators have used pressure varying from 1.5 to 2.5 ATA. However, the lungs in severe TBI patients have frequently been compromised by direct lung injury and/or acquired ventilator pneumonia and are susceptible to oxygen (O2) toxicity. Working within these constraints, it is essential to determine the most effective HBO2 treatment parameters without producing O2 toxicity and clinical complications. This proposed clinical trial is designed to answer these questions and to provide important data to plan a definitive efficacy trial.

Eligibility Criteria

Age Range: 16 years to 65 years

Inclusion Criteria: * Age 16 years or older and 65 years or younger * Present with severe TBI, defined as Glasgow Coma Scale (GCS) of 3 to 8. * Marshall computerized tomography (CT) score \>1 in patients with a GCS of 7 or 8 or patients with an alcohol level \>200 mg/dl * Ability to initiate the first hyperbaric oxygen treatment within 8 hours of admission in patients not requiring a craniotomy/craniectomy or any other major surgical procedure OR * Ability to initiate the first hyperbaric oxygen treatment within 14 hours of admission in patients requiring a craniotomy/craniectomy or major surgical procedure Exclusion Criteria: * First hyperbaric oxygen treatment cannot be initiated within 24 hours of injury * GCS of 3 with mid-position and non-reactive pupils bilaterally (4mm) * Penetrating head injury * Pregnant * Pre-existing neurologic disease (e.g. TBI or stroke or neurodegenerative disorder) with confounding residual neurologic deficits * Unstable acute spinal cord injury * Fixed coagulopathy * Severe hypoxia * Cardiopulmonary resuscitation performed * Coma suspected to de due to primarily non-TBI causes * Any contraindications to the study intervention

Interventions

DRUG

Hyperbaric oxygen (1.5 ATA, no NBH)

DRUG

Hyperbaric oxygen (2.0 ATA, no NBH)

DRUG

Hyperbaric oxygen (2.5 ATA, no NBH)

DRUG

Hyperbaric oxygen (1.5 ATA + NBH)

DRUG

Hyperbaric oxygen (2.0 ATA + NBH)

DRUG

Hyperbaric oxygen (2.5 ATA + NBH)

DRUG

Normobaric Hyperoxia (NBH)

OTHER

Usual Care

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Conditions

Traumatic Brain Injury

Locations

UCSD Medical Center - Hillcrest Hospital

San Diego, California 92103

United States

St. Mary's Medical Center

West Palm Beach, Florida 33407

United States

University of Iowa Hospitals and Clinics

Iowa City, Iowa 52242

United States

University of Kentucky Hospital

Lexington, Kentucky 40536

United States

University of Maryland

Baltimore, Maryland 21201

United States

Detroit Receiving Hospital

Detroit, Michigan 48201

United States

Hennepin County Hospital

Minneapolis, Minnesota 55415

United States

University of Nebraska Medical Center

Omaha, Nebraska 68198

United States

Duke University Hospital

Durham, North Carolina 27710

United States

The Ohio State University Wexner Medical Center

Columbus, Ohio 43210

United States

Hamilton Heath Services

Hamilton, Ontario L8L 2X2

Canada