Hyperbaric Oxygen Evolves as Effective Treatment for Diabetic Wounds, Other Conditions

The nation watched in horror as CNN reported an underground blast at the International Coal Group's Sago Mine early on Jan. 2. The blast produced toxic gas that killed 12 miners, leaving a sole survivor, Randy McCloy. On Jan. 5, CNN announced that doctors planned to treat McCloy with hyperbaric oxygen treatment (HBOT) in an effort to bring him out of a coma. Today, McCloy, who left the hospital on March 30, has regained many of his former functions. He is able to speak, roll his eyes and, according to his wife, demonstrate his sense of humor.

Though HBOT has not been directly attributed for McCloy's progress, the treatment, first introduced in the 1930s for decompression sickness in divers, has helped many recover from oxygen deprivation. The treatment forces 100 percent pure oxygen, up to 10 times the normal oxygen intake level, into damaged and affected areas to restore blood flow and assist in nerve healing. Because many medical professionals recognized the possible benefits of the treatment for conditions beyond the scope of decompression sickness, in 1967, the Undersea and Hyperbaric Medical Society (UHMS), Dunkirk, Md., formed to bring guidance to this branch of medicine. In 1975, 50 hyperbaric specialists from various parts of the world met under the direction of UHMS to form a list of accepted conditions for HBOT treatment, according to the National Hyperbaric Rehab Center, Salt Lake City.

On Nov. 29, 2000, the Centers for Medicare and Medicaid Services (CMS) determined guidelines for HBOT, defining it as "a modality in which the entire body is exposed to oxygen under increased atmospheric pressure." The industry is estimated at $225 million annually in the United States. Research by National Hyperbaric Rehab Center indicates approximately 37 free-standing clinics specializing in HBOT in the United States. Of these facilities, only a few are Medicare approved. HBOT also has been approved by the FDA, American Medical Association and insurance companies for treating certain medical conditions.

HBOT is used for such ailments as open wounds and certain diabetic ulcers, and also complications associated with stroke and ailments that require an effective delivery of oxygen to affected tissue. The CMS policy (20.29) limits coverage to 14 conditions, nine of which involve wounds. Among the conditions covered are acute carbon monoxide intoxication, decompression illness, gas embolism, crush injuries and suturing of severed limbs, progressive necrotizing infections and cyanide poisoning.

Teri Pearce Rich, founder and COO of National Hyperbaric Rehab Center, says that the main uses of HBOT for her clients include carbon monoxide and diabetic wounds. The treatment "will actually get the oxygen back to the damaged tissue, which in turn will enhance the healing process. So you'll actually see the healing process right before your eyes," she says. HBOT spurs new tissue growth, seals wounds and eliminates infections.

CMS accepts HBOT as the primary therapy for only a few conditions. Those conditions include decompression sickness, gas embolism, gas gangrene and acute anoxia as found in carbon monoxide poisoning. Used as an adjunct therapy, however, HBOT produces positive outcomes for a number of conditions. The treatment has proved effective in maximizing limb salvage for potential amputees and has been somewhat effective for restoring damaged brain tissue as the result of traumatic brain injury, such as stroke and cerebral palsy. Hyperbaric therapy is sometimes used to treat burns because it reduces swelling, limits progression of the burn injury (which continues three to four days after the initial injury) and may diminish lung damage from inhalation of heat and smoke.

Rich explains that CMS requires the adherence to strict guidelines for HBOT, including a 30-day waiting period on diabetic wounds. "Hyperbarics is therapeutic," says Rich. "It needs to be ordered by a doctor, a rehab type of doctor, in the house for these purposes because it is considered a prescription. And by your state laws and your federal laws, to not have a doctor in the house while your chamber is in process is against the law. And therefore (you need) to go through normal medical procedures — you need to go through a non-healing process of 30 days."

As HBOT continues to evolve in the medical community, Rich expects the market to grow. "Over the course of the last seven years, hyperbaric therapy has become more mainstream as opposed to alternative," she says. "It is now advanced therapy. You're finding it more in conjunction with wound care in most hospitals. There are also a lot more free-standing facilities popping up all over the place because of the healing properties for neurological conditions such as CP, stroke, MS, chronic fatigue, that kind of scenario. It's being used for a lot of off-label as well as labeled criteria."

National Hyperbaric Rehab Center recently teamed up with the American Diabetes Association (ADA) as a major sponsor. Rich says the company participates with fund raising and patient screening. "We have an involvement with (ADA) where ... we also help with education, with their training," she says. "We go to their facilities to train their workers as well as go with them to the diabetic's home (to) educate (and) treat medically as well as educationally and nutritionally."

For more information on National Hyperbaric Rehab Center, visit www.hyperbaricrehab.com. To view CMS' full list of conditions covered and excluded for HBOT, visit www.cms.hhs.gov/mcd/viewncd.asp?ncd_id=20.29&ncd_version=2&show=all.

Photo: Seacrest 2500, Hyperbaric Oxygen Treatment Chamber, Courtesy of National Hyperbaric Rehab Center, Salt Lake City

This article originally appeared in the April 2006 issue of HME Business.

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