March 09, 2022
Clinical Research, Midlands Diving Chamber, Hospital of St Cross, Rugby, Warwickshire.
Introduction: SARS-CoV-2 affects the innate immune response and activates an inflammatory cascade. Hyperbaric oxygen (HBOT) has proven anti-inflammatory effects. This has been seen in the acute hospitalised phase of infection and evidence has also shown that discharged patients still show Chest X-ray changes of pulmonary fibrosis. Post-SARS studies have shown up to 43% prevalence of impaired lung gas diffusion up to 2 years from discharge.
Previous post SARS studies have shown a high incidence of Post Viral Syndrome, even up to 4 years post-infection and notably high in health workers.
A prevalent symptom of SARS-CoV-2 infection is “silent hypoxia”. When severe, this will lead to the patient’s hospitalization or death. If moderate, the home-isolator can have oxygen saturations below 90% for several days.
There is no evidence as to the long term effects of this, but using a model of the chronic hypoxia of carbon monoxide poisoning – similar symptoms in the Delayed Neuropsychological Syndrome of COP are seen in Post-Covid Syndrome.
Hyperbaric oxygen has been shown to be effective across all 3 aetiologies that can cause chronic symptoms after SARS-CoV-2. Our hypothesis is that early use of HBOT after discharge – in patients, who needed supplemental oxygen whilst hospitalized, will prevent long term symptoms. Our secondary hypothesis is that HBOT will alleviate symptoms in those already with long-term symptoms.
Materials and Methods: This is a pre-trial proposition and if successful will go to a full “randomised, controlled trial for the safety and efficacy of hyperbaric oxygen for the prevention and treatment of chronic post-covid symptoms- “Post-Covid Syndrome”. This will take place at Midlands Diving Chamber, Rugby, Warwickshire.
Study Design: An observational study where positive results will lead to a full RCT
Study Population: 10 patients already with long term symptoms. 10 patients recently discharged who had received supplemental oxygen either CPAP or ventilation
Intervention: HBOT at 2.4 atm for 90 minutes with air breaks. One session daily. 10 in total across 2 weeks.
Control: Current best practise for discharged SARS-CoV-2 patients and those still with chronic symptoms.
Indices: FEV1, FVC , Sa02, TCOM – at MDC // IL6, CRP, DLCO, Lung CT – local provider
Study endpoint: Participants will have 10 HBOT sessions. After this their indices will be compared to those at the beginning. If they have improved and they are symptom free then they will leave the trial with a 30 day follow up. If indices have improved but there are still Post-covid symptoms another 10 sessions of HBOT will be given with follow up after. A maximum of 40 sessions will be allowed.
Results: All results will be peer reviewed and published in a relevant journal. We await a Clinical Trial number
Funding: The Diving Chamber Treatment Trust. Charity Number: 1139049
Summary and Conclusions: A positive result from this observational study will lead to full RCT. The implications of this would new best practice in discharged SARS-CoV-2 patients who needed supplemental oxygen whilst in hospital, as well as a new treatment modality for Post-Covid Syndrome.
December 17, 2021
Hyperbaric oxygen therapy for the treatment of long COVID: early evaluation of a highly promising intervention
Authors: Tim Robbins, Michael Gonevski, Cain Clark, Sudhanshu Baitule, Kavi Sharma, Angel Magar, Kiran Patel, Sailesh Sankar, Ioannis Kyrou, Asad Ali and Harpal S RandevaK
Long COVID is a common occurrence following COVID-19 infection. The most common symptom reported is fatigue. Limited interventional treatment options exist. We report the first evaluation of hyperbaric oxygen therapy (HBOT) for long COVID treatment.
A total of 10 consecutive patients received 10 sessions of HBOT to 2.4 atmospheres over 12 days. Each treatment session lasted 105 minutes, consisting of three 30-minute exposures to 100% oxygen, interspersed with 5-minute air breaks. Validated fatigue and cognitive scoring assessments were performed at day 1 and 10. Statistical analysis was with Wilcoxon signed-rank testing reported alongside effect sizes.
HBOT yielded a statistically significant improvement in the Chalder fatigue scale (p=0.0059; d=1.75 (very large)), global cognition (p=0.0137; d=–1.07 (large)), executive function (p=0.0039; d=–1.06 (large)), attention (p=0.0020; d=–1.2 (very large)), information processing (p=0.0059; d=–1.25 (very large)) and verbal function (p=0.0098; d=–0.92 (large)).
Long COVID-related fatigue can be debilitating and may affect young people who were previously in economic employment. The results presented here suggest potential benefits of HBOT, with statistically significant results following 10 sessions.
KEYWORDS: long COVID, hyperbaric oxygen therapy, fatigue DOI: 10.7861/clinmed.2021-0462
Authors: ANIHR clinical lecturer, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK, Warwick Medical School, Coventry, UK and Coventry University, Coventry, UK; Bhyperbaric doctor, Midlands Diving Chamber, Rugby, UK; Cassistant professor, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK and Coventry University, Coventry, UK; Dclinical fellow, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK; Etrial manager, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK; Fresearch grant coordinator, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK; Gchief medical officer, deputy chief executive officer and consultant cardiologist, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK and Warwick Medical School, Coventry, UK; Hassociate medical director, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK and Warwick Medical School, Coventry, UK; Iassociate professor, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK, Warwick Medical School, Coventry, UK and Coventry University, Coventry, UK; Jconsultant sleep and respiratory physician, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK and Warwick Medical School, Coventry, UK; Kdirector of research and development, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK and Warwick Medical School, Coventry, UK
The COVID-19 pandemic has resulted in the need to support large cohorts of patients suffering from long COVID after recovery from acute infection.1 Long COVID is a term ‘used to describe presence of various symptoms, even weeks or months after acquiring SARS-CoV-2 infection irrespective of the viral status’.2 Long COVID is a common condition, with estimates identifying that between 10% and 20% of people initially diagnosed with acute COVID-19 will go on to develop symptoms of long COVID.3 There remains some debate about the terminology used in long COVID, with the UK National Institute for Health and Care Excellence (NICE) also using the terminology ‘post-COVID-19 syndrome’ for signs and symptoms that develop during or after an infection consistent with COVID-19, continue for more than 12 weeks and are not explained by an alternative diagnosis, and ‘ongoing symptomatic COVID-19’ for signs and symptoms of COVID-19 from 4 to 12 weeks.3 However, NICE also recognises the umbrella term ‘long COVID’.
Long COVID now poses an emerging public health emergency with multiple challenges for the management of these patients in clinical practice.4–6 The symptoms associated with long COVID are diverse, including breathlessness, cough, fatigue, ‘brain fog’, anxiety and depression.7 One of the most commonly reported symptoms is fatigue, present in up to 65% of long COVID patients, this is accompanied by a substantial proportion also reporting cognitive and affective deficits (described in the literature as ‘brain fog’).8–11 The fatigue experienced by these patients can be particularly severe, preventing them from performing their usual work and activities, while the age group most affected by long COVID tends to be economically active adults.12
Currently, specific treatment options for long COVID are limited, with even fewer treatment options available for those suffering from fatigue.13,14 Thus, there is a growing need to identify effective treatments for these patients.15 Despite distinct differences, there are important similarities between long COVID fatigue and chronic fatigue syndrome.9,16
Hyperbaric oxygen therapy (HBOT) is ‘an intervention where an individual breathes near 100% oxygen intermittently while inside a hyperbaric chamber that is pressurized to greater than
sea level pressure (1 atmosphere absolute, or ATA)’.17,18 HBOT is used for both elective (eg soft tissue radiation complications and non-healing chronic wounds) and emergency medical conditions (eg carbon monoxide poisoning, decompression illness and gas embolism).17 In particular, HBOT has been shown to be safe
and effective in the treatment of chronic fatigue syndrome.19,20
At University Hospitals Coventry and Warwickshire NHS Trust, working in direct partnership with the Midlands Diving Chamber
at the Rugby Hospital of St Cross, we proposed that HBOT may be of benefit to people suffering from symptoms of long COVID. The first patient to receive HBOT for long COVID received this on the 11 January 2021. Currently, there is no study to our knowledge which explored the effects of HBOT on long COVID-related fatigue. Here we present the first evaluation of a HBOT service for the treatment of long COVID symptoms internationally.
Hyperbaric oxygen therapy for the treatment of long COVID: early evaluation of a highly promising intervention
We retrospectively evaluated the response of fatigue symptoms of patients with long COVID-related fatigue receiving HBOT
at the Midlands Diving Chamber medical facility, Hospital of
St Cross, Rugby. This retrospective evaluation was approved by the University Hospitals Coventry and Warwickshire NHS Trust COVID-19 Research Ethics Committee through the GAFREC Process (ID: 10026).
We evaluated 10 consecutive patients undergoing HBOT for
long COVID-related fatigue at the Midlands Diving Chamber. All patients were suffering from new fatigue that developed during
or after an infection consistent with COVID-19 and continuing for more than 12 weeks. The clinical inclusion and exclusion criteria for these patients are listed in Table 1.
All patients received 10 HBOT sessions, once daily at 2.4 atmospheres for 1 hour and 45 minutes over 12 days (with a 2-day break in the middle for the weekend).
The responses of these 10 consecutive patients receiving HBOT therapy were evaluated with the primary outcome measure being the change in Chalder fatigue scale between days 1 and 10 of treatment.21 The secondary measure evaluated was the change in the cognitive profile scores of day 1 and day 10, as reported through the NeuroTrax evaluation.22 This scoring included global cognitive score, memory, executive function, attention, information processing speed, visual-spatial, verbal function and motor skills.
In order to investigate differences between day 1 and day 10 undergoing HBOT, Wilcoxon signed-rank testing was conducted and reported alongside corresponding effect sizes (Cohen’s d; classified as small (0.2), medium (0.5), large (0.8) or very large (1.2), and 95% confidence intervals (CIs)).23 In addition, Bayes factors were also calculated to express the probability of a difference given H10 (alternate hypothesis) relative to H01 (null hypothesis), that is, values larger than 1 are in favour of H10 assuming that H01 and H10 are equally likely and using a default prior.24 Bayes factors were reported as the probability of the data given the alternative relative to the null hypothesis or vice-versa (classified as anecdotal (BF1–3), moderate (BF3–10), strong (BF10–30), very strong (BF30–100) or extreme (BF>100)).25–27 Bayesian analysis was concurrently utilised because it permits the amalgamation of discipline-specific knowledge, facilitates direct probability statements to be made pertaining to included parameters (ie population level effects), allows zero effects to be determined, provides estimates of uncertainty around parameter values that are more intuitively interpretable than those from null hypothesis testing alone, and supports in the interpretation of p values.28,29 All analyses were conducted using R software.30
In the present cohort, 60% of the patients were women. The mean average age of participants was 47.5 years (range 24–74). All patients had been suffering from long COVID symptoms for over 3 months.
Participant level and overall group data for all collected validated scores between day 1 and day 10 of HBOT are presented in Table 2.
Wilcoxon signed-rank tests indicated that once daily HBOT for 10 days yielded a statistically significant improvement in Chalder fatigue scale (p=0.0059; d=1.75 (very large)), global cognition (p=0.0137; d=–1.07 (large)), executive function (p=0.0039; d=–1.06 (large)), attention (p=0.0020; d=–1.2 (very large)), information processing speed (p=0.0059; d=–1.25 (very large)) and verbal function (p=0.0098; d=–0.92 (large)). Concomitantly, Bayes factors indicated that the evidence favouring the alternative vs the null hypothesis was moderate for global cognition (BF7.63), executive function (BF7.33) and verbal function (BF4.13); strong for attention (BF12.51) and information processing speed (BF15.32), and very strong for Chalder fatigue index (BF98.13).
All pairwise comparisons including p values, mean differences (95% CIs), Cohen’s d effect sizes and Bayes Factors are presented in Table 2 and Fig 1. Finally, participant level and overall group data for days 1 and 10 are presented in the supplementary material S1.
No adverse events were reported in any of these patients receiving HBOT during this treatment or in the immediate post-treatment phase.
At University Hospitals Coventry and Warwickshire NHS Trust, we have established a dedicated clinician-led clinic for patients presenting with long COVID-related fatigue. The severity of symptoms seen and the impact on quality of life are profound.
Many patients are unable to work (either in manual or office-based roles), drive, participate in their usual physical activity or, at times, engage with their family in the manner they would wish. The treatment options available for such people with severe symptoms of long COVID are limited, with very few interventional options.
Here, to our knowledge, we describe the first evaluated use of HBOT to manage long COVID in the UK or internationally. We report statistically and clinically significant improvements to both the overall fatigue score and a range of cognitive domains using validated scales. The effect size measures calculated are large, suggesting a substantial improvement and, thus, there is a small likelihood these results are due to chance despite the small initial sample size. These are important findings suggesting a possible positive effect of HBOT on the common long COVID-related symptoms of fatigue and ‘brain fog’. These results match with the clinical and qualitative observations of patients receiving the therapy, many of whom report their lives have been transformed.
The mechanism of long COVID is still uncertain.1 One possible hypothesis is that the wide variety of changes that characterise long COVID are a result of prolonged tissue hypoxia.6 This is frequently the common denominator for many diseases that are responsive to HBOT.31 Further research is needed to understand the underlying mechanisms of long COVID and positive responses seen in relation to HBOT.1
While these results are important, they represent only an initial evaluation. Indeed, the sample size consists of only 10 patients. Furthermore, these patients have not been followed up for a prolonged period to assess whether the noted improvements of these long COVID-related symptoms were sustained. Based on initial informal feedback, patients do excellently in the longer term. Thus, there is a need to assess these effects of HBOT in
the context of a randomised placebo-controlled prospective study. However, these initial results suggest that HBOT merits further study as a treatment option for patients presenting with long COVID symptoms (such as fatigue). Given the scale of the emerging long COVID public health emergency globally and the still ongoing COVID-19 pandemic, there is an urgent need
for larger-scale randomised placebo-controlled trials to evaluate the potential impact of HBOT in the context of long COVID. In addition, the creation of a registry of patients receiving HBOT for long COVID symptoms (such as fatigue) in order to obtain follow-up data over time is also suggested. These are both elements of work currently being developed collaboratively between the Midlands Diving Chamber and University Hospitals Coventry and Warwickshire NHS Trust.
Additional supplementary material may be found in the online version of this article at www.rcpjournals.org/clinmedicine:
S1 – Descriptive participant level and overall group data, day 1 vs day 10.
16 Wong TL, Weitzer DJ. Long COVID and Myalgic Encephalomyelitis/ Chronic Fatigue Syndrome (ME/CFS)—A Systemic Review and Comparison of Clinical Presentation and Symptomatology. Medicina 2021;57:418.
17 Kirby JP, Snyder J, Schuerer DJ, Peters JS, Bochicchio GV. Essentials of hyperbaric oxygen therapy: 2019 review. Mo Med 2019;116:176.
18 Moon R. Hyperbaric oxygen therapy indications. Best Publishing Company, 2019.
19 Akarsu S, Tekin L, Ay H et al. The efficacy of hyperbaric oxygen therapy in the management of chronic fatigue syndrome. Undersea Hyperb Med 2013;40:197–200.
20 Hoof EV, Coomans D, Becker PD et al. Hyperbaric therapy in chronic fatigue syndrome. Journal of Chronic Fatigue Syndrome 2003;11:37–49.
21 Jackson C. The Chalder fatigue scale (CFQ 11). Occup Med (Lond) 2015;65:86.
22 Doniger GM. NeuroTraxcomputerized cognitive tests: Test descrip- tions. Medina: NeuroTrax, 2013:1–16.
23 Robbins T, Keung SNLC, Sankar S, Randeva H, Arvanitis TN. Application of standardised effect sizes to hospital discharge outcomes for people with diabetes. BMC Medical Informatics and Decision Making 2020;20:1–6.
24 Eyre EL, Clark CC, Tallis J et al. The effects of combined movement and storytelling intervention on motor skills in South Asian and White children aged 5–6 years living in the United Kingdom. Int J Environ Res Public Health 2020;17:3391.
25 Marsman M, Wagenmakers E-J. Bayesian benefits with JASP. European Journal of Developmental Psychology 2017;14:545–55.
26 Wagenmakers E-J, Marsman M, Jamil T et al. Bayesian inference for psychology. Part I: Theoretical advantages and practical ramifica- tions. Psychon Bull Rev 2018;25:35–57.
27 Wagenmakers E-J, Love J, Marsman M et al. Bayesian inference for psychology. Part II: Example applications with JASP. Psychon Bull Rev 2018;25:58–76.
28 Wasserstein RL, Lazar NA. The ASA statement on p-values: context, process, and purpose. The American Statistician 2016;70:129–133.
29 Amrhein V, Greenland S, McShane B. Scientists rise up against sta- tistical significance. Nature 2019;567:305–7.
30 R Core Team. R: A language and environment for statistical com- puting. R, 2013.
31 Choudhury R. Hypoxia and hyperbaric oxygen therapy: a review. Int J Gen Med 2018;11:431–42.
Address for correspondence: Dr Timothy Robbins, University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK.
December 01, 2021
By Alex Green as featured in Warwickshire World
A revolutionary treatment for long Covid – which saw one patient go from relying on a wheelchair to being able to comfortably walk in just a day – is being conducted at Rugby’s St Cross.
The Advertiser learned of the treatment, being conducted at the Midlands Diving Centre, when a patient called in to praise the project for the profound effect it had, easing their long Covid symptoms.
We got in touch with the centre – and Dr Michael Gonevski, who has been spearheading the revolutionary treatment, invited us to come and see it for ourselves.
The treatment sees patients sitting in the centre’s Hyperbaric Oxygen Chamber, which looks quite like a submarine, for a spell of sessions lasting around an hour-and-a-half for up to two weeks.
The chamber simulates the level of pressure usually found 14 metres underwater – and this causes pure oxygen to be forced into the body, being absorbed by cells and prompting regeneration.
Dr Gonevski, who has previous expertise in both diving and using this method to treat an array of conditions, said he has treated 53 long Covid patients since the beginning of this year – and all of them have shown significant improvement.
“We’ve had people who had not been able to leave the house for 18 months show radical improvement in days, we’ve even had someone who was so ill she was using a wheelchair begin walking again,” Dr Gonevski said.
“Long Covid can be life–changing, and we have been able to either reverse entirely or significantly improve the symptoms of this condition.
“And these changes are permanent – they do not disappear when the treatment is completed.”
One patient who spoke with the Advertiser was in the early stages of the treatment, but he said he had already noticed a profound difference in his symptoms.
The patient, who wished to remain anonymous, was educated to a high level and, before developing long Covid, had been fit enough to climb Mont Blanc.
He explained the debilitating physical and cognitive symptoms of his condition, and shared how hopeless he’d become when doctors told him there was nothing they could do to help.
This patient, like many others who have travelled from across the country, said Dr Gonevski and his staff have given them hope – and a hope justified by the clear results that the treatment gets.
Many of the patients are private, but Dr Gonevski is hoping that the NHS will recognise the life-changing treatment and increase its funding so it can be available to all.
See oxygenhealing.co.uk for more information.
September 06, 2021
Olympic boxer Ben Whittaker revealed that he got his punch back after long Covid with #HBOT at Midlands Diving Chamber.
“The 24-year-old contracted the virus in January and said it had robbed him of his ability to punch – but sessions in a chamber at Midlands Diving Chamber breathing 100 % oxygen in a pressurised environment gave him 100 percent back. He claimed that without it he would not have won silver in Tokyo.”
Check out the article here:
Image and article by Daily Mail, read the full article on the Daily Mail here.
May 12, 2021
Did you know we have been treating patients suffering from the ongoing symptoms of Long COVID and we have seen incredible results?
Professional boxer Rachel Ball saw her symptoms persist for weeks and then months, threatening to end her career until she came to Midlands Diving Chamber for hyperbaric oxygen therapy where we treated her at a therapeutic depth and saw her dreams of recovery come true.
Watch her interview with ITV News now, featuring our very own Dr Michael Gonevski click the image below for the full interview.
If you have any questions or would like more information on treatment for Long COVID please contact us now.
Call: +44 (0) 7931 472602
What’s app: +44 (0) 1788 579 555
June 04, 2020
The health, safety and wellbeing of Tasmanians is our highest priority as we continue to deal with COVID-19.
From tomorrow, the new Department of Diving and Hyperbaric Medicine, with more capacity and capability for patient treatment, research and training, will open in K-Block.
This means more patients can be treated with hyperbaric oxygen simultaneously in the multiplace chamber, which has capacity for up to 10 patients.
There is also a dedicated treatment room for ICU patients who require hyperbaric oxygen treatment.
Patients will enjoy improved amenities in the multiplace chamber with more space, patient entertainment and a private toilet.
Two monoplace chambers are also available for patients who are unable to sit or who cannot tolerate the traditional method of oxygen delivered via a hood or mask.
K3E has more clinical areas with more wound, treatment and consultation rooms.
Tasmania’s new state-of-the-art multiplace, hyperbaric chamber has been designed by Australian experts with clinical and technical advice every step of the way from the Royal Hobart’s hyperbaric team.
Hyperbaric oxygen treatment is a well-known treatment for decompression illness and is essential for Tasmania’s commercial and recreational diving industries.
It is also used to treat other conditions that affect many Tasmanians every year – tissue injury from radiation after treatment for cancer, diabetic wounds and serious infections such as gangrene, for example.
The chamber has been fitted with dual-capability to pressurise (hyperbaric) and depressurise (hypobaric) and is a first for the southern hemisphere.
Hypobaric chambers are used for aerospace, or altitude research and training to simulate the effects of high altitude on the body, especially low oxygen levels and low ambient air pressure.
The dual-capability chamber will create a world-class research facility, unique in the southern hemisphere and one of just a few globally; the first with combined capability in the country.
Meanwhile, following rigorous testing, the helipad will be fully commissioned and ready for patients from Wednesday, May 6, 2020.
Fast, dedicated lifts in K-Block will allow retrieval teams to get patients to their treatment areas within minutes.
This is significantly faster than landing at the Cenotaph, which required transfer by road ambulance to the hospital.
Also, a third inpatient ward will open in K9E on Thursday, May 7, 2020.
The orthopaedics and surgical specialties unit will open 25 beds and includes a bariatric room, negative pressure isolation room and state-of-the-art burns bath with best practice airflows in its own designated area.
Patient services are now being delivered in K-Block with admissions and departures on KG, general and respiratory medicine, K10E and general and vascular surgery, K9W.
We are continuing to monitor the COVID-19 situation daily and will remain flexible in the use of health facilities to best meet the health needs of Tasmanians.
The sequence and opening of more wards and services over coming weeks will continue to be reviewed in light of Tasmania’s COVID-19 preparedness.
Read more: here.