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SARS (Severe Acute Respiratory Syndrome)Phase 2/3COVID-19-HBONCT04327505

Safety and Efficacy of Hyperbaric Oxygen for ARDS in Patients With COVID-19

A Phase 2/3 study testing Hyperbaric oxygen in people with SARS (Severe Acute Respiratory Syndrome) and Cytokine Storm, run by Karolinska Institutet at 3 sites in 2 countries.

Terminated

Stopped early. The study ended before it was planned to and will not resume.

Official record
Search all trials

Trial summary

COVID-19 may cause severe pneumonitis that require ventilatory support in some patients, the ICU mortality is as high as 62%. Hospitals do not have enough ICU beds to handle the demand and to date there is no effective cure. Read more about this study

Who is it for?
Ages 18 to 90 years
What is being tested?
Hyperbaric oxygen
Could I receive a placebo?
No, everyone receives an active treatment
How many people
34 participants
Where
3 sitesin 2 countries
Study dates
3 Jun 2020to 1 Dec 2022
Phase
Phase 2/3
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 90 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Aged 18-90 years
  • PaO2/FiO2 (PFI) below 200 mmHg (26.7 kPa)
  • Suspected or verified SARS-CoV-2 infection
  • At least two risk factors for increased morbidity/mortality
  • Age above 50 years
  • Hypertension
Show all 14Show fewer
  • Cardiovascular disease
  • Diabetes or pre-diabetes
  • Active or cured cancer
  • Asthma/COPD
  • Smoking
  • D-Dimer > 1.0 mg/L
  • Auto-immune disease
  • Documented informed consent according to ICH-GCP and national regulations

Who cannot join

  • ARDS/pneumonia caused by other viral infections (positive for other virus)
  • ARDS/pneumonia caused by other non-viral infections or trauma
  • Known pregnancy or positive pregnancy test in women of childbearing age
  • Patients with previous lung fibrosis more than 10%
  • CT- or Spirometry-verified severe COPD with Emphysema
  • Contraindication for HBO according to local guidelines
Show all 9Show fewer
  • Not likely to need ICU admission < 7 days of screening (Subjective criteria that may exclude any patients that fulfil the other inclusion criteria but where the treating physician suspect a spontaneous recovery)
  • Mental inability, reluctance or language difficulties that result in difficulty understanding the meaning of study participation
  • Prisoner (Exclusion criteria according to IRB at UCSD)

Trial locations and contacts

3 sites in 2 countries.

3 sites in 2 countries

Sweden2 sites
  • Blekingesjukhuset

    Karlskrona, Blekinge County

  • Karolinska University Hospital

    Stockholm, 171 76

Other trials in Sweden

Germany1 site
  • Krankenhaus St. Joesf

    Regensburg, 93053

Other trials in Germany

About this study

Official title: A Randomized, Controlled, Open Label, Multicentre Clinical Trial to Explore Safety and Efficacy of Hyperbaric Oxygen for Preventing ICU Admission, Morbidity and Mortality in Adult Patients With COVID-19

COVID-19 may cause severe pneumonitis that require ventilatory support in some patients, the ICU mortality is as high as 62%. Hospitals do not have enough ICU beds to handle the demand and to date there is no effective cure.

We explore a treatment administered in a randomized clinical trial that could prevent ICU admission and reduce mortality.

The overall hypothesis to be evaluated is that HBO reduce mortality, increase hypoxia tolerance and prevent organ failure in patients with COVID19 pneumonitis by attenuating the inflammatory response.

Read the detailed description

Main objective: To evaluate if HBO reduce the number of ICU admissions compared to Best practice for COVID-19

Secondary objectives:

Main secondary objectives:

To evaluate if HBO:

  • reduces mortality in severe cases of COVID-19.
  • reduces morbidity associated with COVID-19.
  • reduce the load on ICU resources in COVID-19.
  • mitigate the inflammatory reaction in COVID-19.

Other secondary objectives (in selection):

To evaluate if HBO is safe for SARS-CoV-2 positive patients and staff.

Study design: Randomized, controlled, phase II, open label, multicentre

Study population: Adult patients with SARS-CoV-2 infection, with at least two risk factor for increased mortality, likely to develop ARDS criteria and need intubation within 7 days of admission to hospital.

Number of subjects: 200 (20+180)

Investigational product: Hyperbaric oxygen (HBO) compared with best practice treatment HBO: HBO 1.6-2.4 ATA for 30-60 min, maximum 5 treatments first 7 days Control: Best practice treatment for COVID-19

Being tested
Hyperbaric oxygen
Keywords
COVID-19, Hyperbaric oxygen, ARDS, SARS-CoV-2, ICU admission
Medical subject headings
Severe Acute Respiratory Syndrome, Cytokine Release Syndrome, Respiratory Distress Syndrome, COVID-19

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Hyperbaric oxygenDrug

    Also called HBO

    1.6- 2.4 ATA, 30-60 min (excluding compression/recompression)

Study groups in NCT04327505
Study groupRoleWhat they receive
Hyperbaric oxygenExperimentalHyperbaric oxygen 1,6-2.4 Bar for 30-60 minutes (compression/decompression time, according to local routines) in addition to best practice
Receives: Drug: Hyperbaric oxygen
ControlNo interventionBest practice

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. ICU admission

    The proportion of subjects admitted to ICU from day 1 to day 30, based on at least one of the following criteria:

    1. Rapid progression over hours ii) Lack of improvement on high flow oxygen >40L/min or non invasive ventilation with fraction of inspired oxygen (FiO2) > 0.6 iii) Evolving Hypercapnia or increased work of breathing not responding to increased oxygen despite maximum standard of care available outside ICU iv) Hemodynamic instability or multi organ failure with maximum standard of care available outside ICU

    Measured: Through study completion 30 days

Secondary outcomes (5)
  1. 30-day mortality

    Proportion of subjects with 30-day mortality, all cause Mortality, from day 1 to day 30.

    Measured: Through study completion 30 days

  2. Time-to-intubation

    Time-to-Intubation, i.e. cumulative days free of invasive mechanical ventilation, from day 1 to day 30

    Measured: Through study completion 30 days

  3. Time-to-ICU

    Time-to-ICU, i.e. cumulative ICU free days, derived as the number of days from day 1 to ICU, where all ICU free subjects are censored at day 30.

    Measured: Through study completion 30 days

  4. Inflammatory response

    Mean change in inflammatory response from day 1 to day 30.

    1. White cell count + differentiation
    2. Procalcitonin
    3. C-Reactive protein
    4. Cytokines (IL-6) (if available at local laboratory)
    5. Ferritin
    6. D-Dimer
    7. LDH

    Measured: Through study completion 30 days

  5. Overall survival

    Overall survival (Kaplan-Meier)

    Measured: Through study completion 30 days

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted31 Mar 2020
  2. Study start3 Jun 2020
  3. Primary completion30 Jun 2022
  4. Study completion1 Dec 2022

Why it stopped: Futility, change of disease due to virus mutations and/or vaccination

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 2/3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
Randomized controlled, open label, multi-centre clinical trial
Masking
None (open label)
Enrolment
34 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04327505
Sponsor's protocol ID
COVID-19-HBO
Other IDs
2020-001349-37, K-1199/2020
Acronym
COVID-19-HBO
Status last verified
Jan 2023
First submitted
25 Mar 2020
Last updated
9 Jan 2023
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: The full study protocol, statistical plan and consent form will be publicly available when results are published. Data will be available on patient level; data will be pseudonymized. The full dataset and statistical code will be available upon request.

Publications

  • Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, Xiang J, Wang Y, Song B, Gu X, Guan L, Wei Y, Li H, Wu X, Xu J, Tu S, Zhang Y, Chen H, Cao B. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020 Mar 28;395(10229):1054-1062. doi: 10.1016/S0140-6736(20)30566-3. Epub 2020 Mar 11.

    PubMed 32171076
  • Oscarsson N, Muller B, Rosen A, Lodding P, Molne J, Giglio D, Hjelle KM, Vaagbo G, Hyldegaard O, Vangedal M, Salling L, Kjellberg A, Lind F, Ettala O, Arola O, Seeman-Lodding H. Radiation-induced cystitis treated with hyperbaric oxygen therapy (RICH-ART): a randomised, controlled, phase 2-3 trial. Lancet Oncol. 2019 Nov;20(11):1602-1614. doi: 10.1016/S1470-2045(19)30494-2. Epub 2019 Sep 16.

    PubMed 31537473
  • Thibodeaux K, Speyrer M, Raza A, Yaakov R, Serena TE. Hyperbaric oxygen therapy in preventing mechanical ventilation in COVID-19 patients: a retrospective case series. J Wound Care. 2020 May 1;29(Sup5a):S4-S8. doi: 10.12968/jowc.2020.29.Sup5a.S4.

    PubMed 32412891
  • Gorenstein SA, Castellano ML, Slone ES, Gillette B, Liu H, Alsamarraie C, Jacobson AM, Wall SP, Adhikari S, Swartz JL, McMullen JJS, Osorio M, Koziatek CA, Lee DC. Hyperbaric oxygen therapy for COVID-19 patients with respiratory distress: treated cases versus propensity-matched controls. Undersea Hyperb Med. 2020 Third Quarter;47(3):405-413. doi: 10.22462/01.03.2020.1.

    PubMed 32931666
  • Kjellberg A, De Maio A, Lindholm P. Can hyperbaric oxygen safely serve as an anti-inflammatory treatment for COVID-19? Med Hypotheses. 2020 Nov;144:110224. doi: 10.1016/j.mehy.2020.110224. Epub 2020 Aug 30.

    PubMed 33254531
  • Kjellberg A, Zhao A, Lussier A, Hassler A, Al-Ezerjawi S, Bostrom E, Catrina SB, Bergman P, Rodriguez-Wallberg KA, Lindholm P. Hyperbaric oxygen therapy as an immunomodulatory intervention in COVID-19-induced ARDS: Exploring clinical outcomes and transcriptomic signatures in a randomised controlled trial. Pulm Pharmacol Ther. 2024 Dec;87:102330. doi: 10.1016/j.pupt.2024.102330. Epub 2024 Oct 10.

    PubMed 39393522
  • Kjellberg A, Douglas J, Hassler A, Al-Ezerjawi S, Bostrom E, Abdel-Halim L, Liwenborg L, Hetting E, Jonasdottir Njastad AD, Kowalski J, Catrina SB, Rodriguez-Wallberg KA, Lindholm P. COVID-19-Induced Acute Respiratory Distress Syndrome Treated with Hyperbaric Oxygen: Interim Safety Report from a Randomized Clinical Trial (COVID-19-HBO). J Clin Med. 2023 Jul 24;12(14):4850. doi: 10.3390/jcm12144850.

    PubMed 37510965
  • Kjellberg A, Douglas J, Pawlik MT, Kraus M, Oscarsson N, Zheng X, Bergman P, Franberg O, Kowalski JH, Nyren SP, Silvanius M, Skold M, Catrina SB, Rodriguez-Wallberg KA, Lindholm P. Randomised, controlled, open label, multicentre clinical trial to explore safety and efficacy of hyperbaric oxygen for preventing ICU admission, morbidity and mortality in adult patients with COVID-19. BMJ Open. 2021 Jul 5;11(7):e046738. doi: 10.1136/bmjopen-2020-046738.

    PubMed 34226219

Questions about this trial

What is this clinical trial studying?

A Phase 2/3 study testing Hyperbaric oxygen in people with SARS (Severe Acute Respiratory Syndrome) and Cytokine Storm, run by Karolinska Institutet at 3 sites in 2 countries.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 14 inclusion and 9 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: stopped early, as of the sponsor's last update on 9 Jan 2023. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 3 sites in Sweden, Germany. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this combined phase mean?

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study was stopped early (reason given: Futility, change of disease due to virus mutations and/or vaccination). Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

ICU admission (time frame: Through study completion 30 days). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04327505, which also lists 8 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 9 Jan 2023.

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