Criteria for using HBO in acute traumatic ischemia

The jury of the 7th ECHM Consensus Conference organised by the European Committee for Hyperbaric Medicine (ECHM) issued recommendations on the use of HBO treating crush injury and other acute traumatic ischemia. They used a 3 grade scale according to the strength each recommendation has been evaluated:

Type 1 : Strongly Recommended. The jury considers the implementation of the recommendation of critical importance for final outcome of the patient.

Type 2 : Recommended. The jury considers the implementation of the recommendation as positively affecting final outcome of the patient.

Type 3 : Optional. The jury considers the implementation of the recommendation as an option.

The jury also reported the level of evidence which supports, in its view, the recommendation.

Level A : Recommendation supported by level 1 evidence Level B : Recommendation supported by level 2 evidence Level C : Recommendation supported only by level 3 evidence

Following these principles the jury came to the following recommendations regarding acute soft tissue ischemia:

• HBO2 is recommended in post traumatic crush injury following open fracture Gustilo type III B and C (Type 1 recommendation, level B)

• HBO2 is optional in reperfusion syndromes following invasive vascular procedure (Type 3 recommendation, level C)

• HBO2 is recommended in compromised skin grafts and myo-cutaneous flaps (Type 2 recommendation, level C)

• HBO2 is optional in the replantation of traumatically amputated limb segment (Type 3 recommendation, level C)

• In every case, the measurement of transcutaneous oxygen pressure is recommended as an index for the definition of the indication and of the evolution of treatment (Type 1 recommendation, level B)

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