Speaker: Marc Robins, DO
Time: 8:00 am - 8:30 am
Speaker: John Feldmeier, DO, FACRO, FUHM
Time: 8:30 am - 9:15 am
About the Lecture:
By early spring of 2020, COVID-19 had become a major worldwide public health issue. The medical community struggled to find new therapeutic interventions and fell back on the application of already available medications and technologies. Early in the process several independent parties concluded that hyperbaric oxygen would likely offer relief from the severe hypoxemia suffered by many of those infected. Experience in the United States as well as internationally is reported in a handful of publications. The best of these in its scientific design is the study from NYU by Gorenstein et al which employed the design of propensity matching for establishing a control group for their 20 hyperbaric treated patients. They conclude that HBO2 was safe in this group but stop short of advocating treatment due to the limited experience. Anecdotally now, over 100 patients have been treated. The treating clinicians, when contacted, report consistently positive and even dramatic results in most cases. With the development of and distribution of vaccines, current predictions anticipate a considerable decrease, if not eradication of acute infections. However, we still seek effective treatments for those who experience continued symptoms after recovery from the acute infection and have been termed the “long haulers.”
This presentation seeks to identify the likely mechanisms whereby hyperbaric oxygen is likely to favorably impact both acute COVID and the ongoing sequelae for the “long-haulers.” In addition to the successful relief of hypoxemia, hyperbaric oxygen has known anti-inflammatory properties and for reasons that will be discussed should ameliorate the cytokine storm associated with the over-active immune response to the infection. Some preliminary data suggest that HBO2 may reduce the diffuse hypercoagulation that has been seen in many patients. We will discuss a likely positive impact on oxygen debt and the potential positive impact in recruiting marrow and mesenchymal stem cells when COVID-19 patients receive hyperbaric treatment.
About Dr. Feldmeier
Dr. Feldmeier received his D.O. degree from The Philadelphia College of Osteopathic Medicine in 1979 with USAF sponsorship and completed residency training in Radiation Oncology at the University of Texas Health Science Center at San Antonio, Texas in 1985. He received a fellowship certificate from the USAF Hyperbaric Medicine Fellowship Training Program at Brooks Air Force Base in San Antonio, Texas and was a staff physician there from 1980 to 1982. Dr. Feldmeier was simultaneously the Chief of Radiation Oncology and Chairman of the Hyperbaric Medicine Department at Wright-Patterson Air Force Base Medical Center in Dayton, Ohio before separating from the USAF in 1985. Dr. Feldmeier has served as the Chief of Radiation Oncology at the University of Texas Health Science Center in San Antonio, Grace Hospital in Detroit, MI and the Chairman of Radiation Oncology at the University of Toledo Medical Center from which he retired in 2013 with the award of Professor Emeritus. Dr. Feldmeier has authored numerous publications in both radiation oncology and hyperbaric medicine. He has been the editor of the Undersea & Hyperbaric Medical Society (UHMS) Hyperbaric Oxygen Therapy Committee Report. He served as review editor of Undersea and Hyperbaric Medicine. He is a Fellow of Undersea and Hyperbaric Medicine and Past- President of the UHMS. He currently co-chairs the UHMS Research Committee. He is a Fellow of the American College of Radiation Oncology. He is a medical consultant to International ATMO. He is the only physician in the U.S. board certified in both Radiation Oncology and Undersea and Hyperbaric Medicine.
Speaker: Scott Gorenstein, MD; David Lee, MD; Sandra Wainwright, MD
Time: 9:15 am - 10:00 am
About the Lecture:
Understand the physiology of HBO and COVID 19. Recognize the safety concerns with COVID 19 and HBO. What are the implications of this clinical trial.
About Dr. Gorenstein:
I am a board certified Emergency Physician with additional board certification in Undersea and Hyperbaric Medicine. I have over 20 years of experience and have authored over 20 peer reviewed articles. I have been involved in translational research and currently participate in several industry sponsored clinical trials.
About Dr. Lee
About Dr. Wainwright:
Sandra Wainwright, MD Medical Director of the Hyperbaric and Wound Healing Center Greenwich Hospital, Yale New Haven Health
Boarded in Internal Medicine, Pulmonary and Critical Care Medicine
Born in Georgia grew up all over the US and Japan as part of an military family
Graduated from Pacific Lutheran University in Tacoma, WA with a Chemistry degree
Pursued MD at St. Georges University School of Medicine in Grenada, West Indies
The year 2020 resulted in the unusual confluence of my Pulm/cc training and Hyperbaric medicine, such that I understood and began to explore the extent of hypoxia from COVID pneumonia and began to ask the questions of how do we address hypoxia with existing equipment and knowledge?
Speaker: Brian Mac Grory, MD
Time: 10:50-11:40 AM
Central retinal artery occlusion is a form of acute ischemic stroke. Despite over 150 years of research there are no widely available, effective forms of treatment. Administration of hyperbaric oxygen is a compelling treatment avenue as the dual blood supply to the retina (from the central retinal artery and choroidal circulations) means that systemic hyperoxia can rescue ischemic retinal cells and act as a critical temporizing measure to arrest visual loss. In this talk, Dr. Mac Grory discusses the pathophysiology of CRAO, recent advances in our understanding of this condition and the central role that hyperbaric oxygenation may play in its treatment.
About Dr. Mac Grory:
Dr. Mac Grory is a vascular and general neurologist. His subspecialty training is in vascular neurology which includes the treatment of stroke and other disorders affecting the blood vessels in the brain and neck. He also treats people with seizures, headaches, autoimmune conditions affecting the brain and spine, disorders of movement, and disorders of muscle. He sees patients in the inpatient service at Duke University Medical Center (DUMC), in the outpatient clinic and also via telemedicine (as part of a group of specialists who are on call 24/7 to provide virtual stroke consultations to a network of hospitals in North Carolina and Virginia). Additionally, he is setting up a multidisciplinary clinic at DUMC in which a vascular neurologist and ophthalmologist collaboratively see patients who have suffered a stroke affecting their eye (see below) and work together to preserve a person’s eye health while preventing further strokes in the future.
Topic: The International Multicenter Registry for Hyperbaric Oxygen Therapy:
Dr. Buckey will discuss the organization, operations, and results from the multicenter registry for hyperbaric oxygen therapy. This registry consists of a consortium of hyperbaric centers that have agreed to collect a defined set of outcome measures on all of their patients. The advantages and disadvantages of this approach will be discussed along with a presentation of recent results.
About Dr. Buckey:
Dr. Buckey is a professor of medicine at the Geisel School of Medicine at Dartmouth and is the medical director of the center for hyperbaric medicine at the Dartmouth-Hitchcock Medical Center. He is currently the chair of the Multicenter Registry for hyperbaric oxygen therapy.
Topic: The role of the specialist registry in research and practice.
Registries are becoming common. Whilst some are designed for a specific purpose, others aim to collect data on a broad range of practice and offer scope to answer many questions that may not yet have been asked. Placing the data generated within the traditional framework of clinical evidence can be challenging, as can the interface between registry and both electronic medical records and billing procedures. This presentation will introduce some of these challenges and use established registries to help place efforts in our own field into context.
About Dr. Bennett:
Professor Bennett is the Academic Head of the Department of Anaesthesia, a Senior Staff Specialist in diving and hyperbaric medicine at Prince of Wales Hospital and Conjoint Professor in the faculty of Medicine, University of New South Wales in Sydney, Australia. He graduated from the University of New South Wales in 1979 and spent his early post-graduate training at the Prince Henry/Prince of Wales Hospitals before undertaking training in Anaesthesia in the UK. He returned to Sydney in 1990 as a retrieval specialist on the Lifesaver Helicopter and here developed an interest in both diving and hyperbaric medicine. He was medical director of the Department of Diving and Hyperbaric Medicine at POWH from 1993 to 2007.
He also has a strong interest in clinical epidemiology and is an experienced clinician and researcher. In 2002 he was the recipient of the Behnke Award for outstanding scientific achievement from the Undersea and Hyperbaric Medical Society. Since 2004 he has been highly involved in the teaching of Evidence-based Medicine within the Medical faculty at UNSW and in 2005 was appointed co-director of the Quality Medical Practice Program there. He is the author of over 140 peer-reviewed publications including 15 Cochrane reviews of the evidence in Diving and Hyperbaric Medicine. Prof. Bennett was the convenor of the Australia and New Zealand Hyperbaric Medicine Group Introductory Course in Diving and Hyperbaric Medicine from its inception in 1999 to 2014. He is an executive member of the Australia and New Zealand College of Anaesthetists (ANZCA) special interest group in diving and hyperbaric medicine and chair of the ANZCA DHM subcommittee responsible for the ANZCA Diploma of Advanced DHM. He is a past Vice-President of the UHMS and a past President of SPUMS.
Topic: How Specialty Societies in the U.S. use CMS Approved Qualified Clinical Data Registries to Ensure their Survival
The U.S. Wound Registry is recognized by the Centers for Medicare and Medicaid Services (CMS) as a Qualified Clinical Data Registry (QCDR). The USWR hosts the Hyperbaric Oxygen Therapy Registry (HBOTR), provides quality reporting to physicians who participate in the Quality Payment Program, and archives structured data for research. HBOTR data has already been used to protect the hyperbaric chamber supervision payment rate which was threatened with a significant reduction. Data are transmitted electronically from certified electronic medical records (EHRs).
About Dr. Fife:
Dr. Fife completed a Family Medicine residency at the University of Texas, Southwestern in Dallas followed by a two year Fellowship in Undersea and Hyperbaric Medicine at Duke University. Until 2013 she was a Professor of Medicine at the University of Texas Health Science Center, Houston where she initiated the Memorial Hermann Center for Wound Healing and Hyperbaric Medicine and the Lymphedema Center. She is now a Professor of Geriatrics at Baylor College of Medicine in Houston, and the Medical Director of the CHI St. Luke's Wound Clinic in The Woodlands, Texas. She is also the Chief Medical Officer of Intellicure, Inc., a health information technology company, and the Executive Director of the U.S. Wound Registry, a non-profit organization recognized by CMS as a qualified clinical data registry. The USWR develops quality measures and helps wound care and hyperbaric practitioners meet the requirements of Medicare’s new Quality Payment Program. She has been a Certified Wound Specialist since 1998 and is a past president of the Undersea and Hyperbaric Medical Society. Past and present board activities include the Alliance of Wound Care Stakeholders (current co-chair), the American Academy of Wound Management, the Association for the Advancement of Wound Care and the American Professional Wound Care Association. She is the clinical editor of Today’s Wound Clinic, and has authored more than 100 peer reviewed articles and book chapters as well as editing 3 textbooks (the Textbook of Chronic Wound Care, Wound Care Practice, and Women and Pressure: Diving and Flying.). Her research contributions include altitude decompression studies that enabled the construction of the International Space Station by decreasing the time needed for oxygen pre-breathe as part of a NASA lead research consortium, the development of real time lymphatic imaging with Dr. Eva Sevick using near infrared technology, and more recently, the use of real world data for comparative effectiveness studies to understand what works best for patients with chronic wounds and ulcers.