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Referencias
References to studies included in this review
References to studies excluded from this review
Additional references
Characteristics of studies
Characteristics of included studies [ordered by study ID]
Ir a:
| Study characteristics | ||
| Methods | Unblinded randomised controlled trial, method of allocation and randomisation not described. | |
| Participants | 74 subjects enrolled with firm diagnosis of AMI. Excluded those with heart failure, severe arrhythmias and over 70 years. The mean age of subjects in the HBOT group was 55 yrs (sd 7) and in the control group 54 yrs (sd 8). 22% of the HBOT group were female, as were 8% of the control group and 22% were diabetic compared to 5% of the controls. | |
| Interventions | Control had thrombolysis with 1.5m IU streptokinase over 30 minutes. Experimental group had the same, plus a single session of HBOT at 2.0 ATA for 60 minutes (mean time to treatment 13hrs). | |
| Outcomes | Peak creatine kinase, LV function, death | |
| Notes | Echocardiographer was blinded to therapy. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | "With a random number table, patients were randomly assigned to..". |
| Allocation concealment (selection bias) | Unclear risk | No description of attempts at concealment. |
| Blinding (performance bias and detection bias) | High risk | There was no sham therapy and the patient and investigators were all aware of group allocation. "The patients randomly assigned to streptokinase plus HBO were transferred to the hyperbaric unit in the first 24 hours from the onset of symptoms and after thrombolytic therapy." Echocardiographer was blinded to therapy. |
| Incomplete outcome data (attrition bias) | Low risk | No withdrawals or loss to follow‐up. |
| Selective reporting (reporting bias) | Low risk | The published report likely contains all relevant outcomes intended. |
| Other bias | Low risk | No clear source suggesting other biases. |
| Study characteristics | ||
| Methods | Unblinded randomised controlled trial. Randomisation by computer generated sequence, but allocation method unclear. | |
| Participants | 129 subjects enrolled with ECG or biochemical evidence of AMI between 3 and 10 days prior to enrolment and aged 30 to 75 years. The mean age of subjects in both the HBOT and control groups was 55 yrs (sd 1). The authors stated that the sex ratio was the same for both groups but did not give the exact figures. | |
| Interventions | Control group had usual therapy including thrombolysis when indicated. Experimental group the same with the addition of HBOT at 1.3ATA for 40 minutes daily for six days. | |
| Outcomes | Mortality, reinfarction | |
| Notes | Not possible to tell if the two outcomes are mutually exclusive or not. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Computer generated random number table ("randomly divided into two groups with computer technology"). |
| Allocation concealment (selection bias) | Unclear risk | No statement in report. |
| Blinding (performance bias and detection bias) | High risk | No sham therapy administered. |
| Incomplete outcome data (attrition bias) | Low risk | Seven participants in each arm refused to continue in the study shortly after enrolment. |
| Selective reporting (reporting bias) | Low risk | No evidence of outcomes not reported |
| Other bias | Unclear risk | Little information upon which to make this judgement. |
| Study characteristics | ||
| Methods | Multicentred, randomised trial. Allocation method not described. No blinding. 16 subjects excluded after randomisation. | |
| Participants | 138 subjects enrolled in emergency room the numbers randomised to each arm were not reported. Patients in emergency room with AMI diagnosed by clinical features and ECG changes, and who were eligible for thrombolysis. Age 18 to 80 years. 16 excluded due to haemodynamic instability, no proven AMI, exceeded time limit for thrombolysis, incorrect protocol, incomplete data or refusal of HBOT. The mean age of subjects in both the HBOT and control groups was 59 yrs (sd 12) . 19% of the HBOT group were female, as were 26% of the control group. | |
| Interventions | Controls received thrombolysis, aspirin, heparin and intravenous nitroglycerine. HBO group received the same plus 1 treatment of 2ATA 100% oxygen for 2 hours. | |
| Outcomes | Death, time to pain relief, magnitude of enzyme change, left ventricular ejection fraction. Length of stay | |
| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | "With a random number table, patients were randomised to ...". |
| Allocation concealment (selection bias) | Unclear risk | No description given of possible allocation concealment. |
| Blinding (performance bias and detection bias) | High risk | There was no sham therapy. "The patients randomised to HBO were then immediately transferred to the hyperbaric unit..". LVEF measures were observer blinded. |
| Incomplete outcome data (attrition bias) | Low risk | Missing data balanced between groups and unlikely to have affected result. Exclusions described. |
| Selective reporting (reporting bias) | Low risk | All expected outcomes seem to be included. |
| Other bias | High risk | No indication of other important sources of bias. |
| Study characteristics | ||
| Methods | Randomised controlled trial without blinding or allocation concealment. Patients refusing HBOT crossed over to control (5 subjects). Analysis by intention to treat is therefore not possible. | |
| Participants | 69 subjects enrolled (33 HBOT, 36 control) with clinical diagnosis of acute AMI or unstable angina, but were excluded if pain was ongoing, or S‐T segments unresolved after 30 minutes of medical therapy. The mean age of subjects in the HBOT group was 63 yrs (sd 12) and in the control group 65 yrs (sd 13). 42% of the HBOT group were female, as were 43% of the control group. 5 subjects crossed from HBOT to control after refusal or early termination of HBOT, while a further 4 subjects from each group did not require PCI. Therefore final analysis of 24 HBOT and 37 control subjects. | |
| Interventions | Controls underwent stenting and received aspirin, heparin and clopidogrel. Experimental subjects received HBOT at 2ATA for 90 minutes 1 hour prior to or immediately following stent, and a second treatment within 18 hours. Medical therapy was the same for both groups. | |
| Outcomes | MACE, adverse events | |
| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | No method of randomisation was described. "33 were randomised to the HOT arm and 36 to the control group...". |
| Allocation concealment (selection bias) | Unclear risk | No description of allocation concealment. |
| Blinding (performance bias and detection bias) | High risk | There was no sham therapy. "All patients in the HOT arm underwent two hyperbaric dives...". |
| Incomplete outcome data (attrition bias) | High risk | Five patients crossed from HBOT to control arm. ITT analysis not possible. |
| Selective reporting (reporting bias) | Low risk | "The prespecified primary endpoints consisted of the composite endpoints of death, MI, emergent coronary bypass surgery and target lesion revascularization...". All were reported. |
| Other bias | Low risk | No indication of other significant bias. |
| Study characteristics | ||
| Methods | Randomised controlled trial with concealed allocation. Schedule called for 2 active for each control subject. No loss to follow‐up and subjects were blinded with sham therapy. | |
| Participants | 34 subjects (24 HBOT, 10 control) enrolled with firm clinical diagnosis of AMI within the past week, plus abnormal wall motion on transoesophageal echo. Uncontrolled heart failure excluded. Most had received thrombolysis. The mean age of subjects in the study was 58 yrs with a range from 27 to 70 yrs ‐ the figures for each group were not given. 10% of the subjects were female. | |
| Interventions | Control group had echocardiography, exposure to 2ATA breathing air for 30 minutes and repeat echo. HBOT group had same schedule but breathed 100% oxygen at 2ATA | |
| Outcomes | Improved LV function on echocardiography. No follow‐up past the immediate post‐HBOT phase. Outcome assessors were blinded and shown results in random sequence. | |
| Notes | Perhaps not designed as a therapeutic trial, but does satisfy entry criteria and measured a short‐term outcome. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | No method of sequence allocation described. "Patients... were randomly allocated to received either room air or 100% oxygen." |
| Allocation concealment (selection bias) | Unclear risk | No method described. |
| Blinding (performance bias and detection bias) | Low risk | Sham therapy such that patient and investigators were blind. "Patients were pressurised to 2ATA for 30 minutes and were randomly allocated....". |
| Incomplete outcome data (attrition bias) | Unclear risk | Some results are composite outcomes of individual segments of heart, so hard to tell if there is missing data. All individuals seem to be represented. |
| Selective reporting (reporting bias) | Low risk | All outcomes of interest to investigators seem to be reported. |
| Other bias | Low risk | No obvious source of bias. |
| Study characteristics | ||
| Methods | Sealed envelope randomisation, no blinding after allocation to group. 13 subjects withdrawn due to misdiagnosis or age recorded wrongly. | |
| Participants | 221 subjects (110 HBOT, 111 control) with strong clinical probability of myocardial infarction at admission, aged <70 years. 13 later excluded because of misdiagnosis or exceeded age limit.The mean age of subjects in the two groups was not give, but the age distribution was similar in the two groups, with the majority of subjects aged between 45 and 64 years. 15% of the HBOT group were female, as were 17% of the control group. | |
| Interventions | Control: "full orthodox coronary care including oxygen at 6 lpm by mask." | |
| Outcomes | Death at 3 weeks, rate of significant dysrhythmias, adverse effects. MACE not given as death and significant dysrhythmia may have been reported in the same individual. | |
| Notes | Some indication that HBOT subjects may have been more severely ill than control. Quality assessment: Randomisation: not described, Allocation: B, Performance Bias: unblinded, Detection bias: not described. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Method unclear. "...sealed envelopes giving the random allocation..". |
| Allocation concealment (selection bias) | Low risk | Used sealed envelopes to reveal allocation. "Peel Index (was done)...as soon as possible after entry into the trial and before opening the sealed envelopes giving the random allocation into treatment and control groups.". |
| Blinding (performance bias and detection bias) | High risk | No sham therapy. |
| Incomplete outcome data (attrition bias) | Low risk | Primary outcome accounted for all patients after exclusions. |
| Selective reporting (reporting bias) | Low risk | All outcomes of interest apparently addressed. |
| Other bias | Unclear risk | Despite randomisation, the HBOT group was in general a little more unwell |
AMI ‐ acute myocardial infarction
ATA ‐ atmospheres absolute
HBOT ‐ Hyperbaric Oxygen therapy
lpm ‐ litres per minute
Characteristics of excluded studies [ordered by study ID]
Ir a:
| Study | Reason for exclusion |
| Case series, no comparator group | |
| This is an animal experiment. "The experiments were conducted on unselected rabbits" | |
| Not an RCT. "Based on financial situations, the participants were separated into 2 groups" | |
| RCT enrolling patients with angina, including unstable angina, but cannot obtain results broken down by functional class. | |
| Animal study |
Data and analyses
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1.1 Death at any time Show forest plot | 5 | 614 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.58 [0.36, 0.92] |
| Analysis 1.1  Comparison 1: Death, Outcome 1: Death at any time | ||||
| 1.1.1 Subjects presenting in cardiogenic shock | 1 | 12 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.61 [0.32, 1.18] |
| 1.1.2 Subjects presenting without cardiogenic shock | 5 | 602 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.57 [0.33, 0.98] |
| 1.2 Death ‐ best case scenario Show forest plot | 5 | 617 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.37 [0.23, 0.58] |
| Analysis 1.2  Comparison 1: Death, Outcome 2: Death ‐ best case scenario | ||||
| 1.3 Death ‐ worst case scenario Show forest plot | 5 | 617 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.34 [0.91, 1.96] |
| Analysis 1.3  Comparison 1: Death, Outcome 3: Death ‐ worst case scenario | ||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 2.1 Major Adverse Cardiac Events Show forest plot | 1 | 61 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.12 [0.02, 0.85] |
| Analysis 2.1  Comparison 2: Major Adverse Cardiac Events, Outcome 1: Major Adverse Cardiac Events | ||||
| 2.2 MACE ‐ Best case scenario Show forest plot | 1 | 69 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.09 [0.01, 0.61] |
| Analysis 2.2  Comparison 2: Major Adverse Cardiac Events, Outcome 2: MACE ‐ Best case scenario | ||||
| 2.3 MACE ‐ worst case scenario Show forest plot | 1 | 69 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.56 [0.23, 1.40] |
| Analysis 2.3  Comparison 2: Major Adverse Cardiac Events, Outcome 3: MACE ‐ worst case scenario | ||||
| 2.4 Recurrent acute myocardial infarction (AMI) Show forest plot | 1 | 129 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.28 [0.08, 0.95] |
| Analysis 2.4  Comparison 2: Major Adverse Cardiac Events, Outcome 4: Recurrent acute myocardial infarction (AMI) | ||||
| 2.5 Recurrent AMI ‐ best case scenario Show forest plot | 1 | 129 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.17 [0.05, 0.55] |
| Analysis 2.5  Comparison 2: Major Adverse Cardiac Events, Outcome 5: Recurrent AMI ‐ best case scenario | ||||
| 2.6 Recurrent AMI ‐ Worst case scenario Show forest plot | 1 | 129 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.92 [0.42, 2.02] |
| Analysis 2.6  Comparison 2: Major Adverse Cardiac Events, Outcome 6: Recurrent AMI ‐ Worst case scenario | ||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 3.1 Overall (CHB, VF and asystole combined) Show forest plot | 1 | 208 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.59 [0.39, 0.89] |
| Analysis 3.1  Comparison 3: Significant dysrhythmias (complete heart block, ventricular fibrillation, asystole), Outcome 1: Overall (CHB, VF and asystole combined) | ||||
| 3.2 Significant dysrrythmias (complete heart block, ventricular fibrillation or asystole) Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| Analysis 3.2  Comparison 3: Significant dysrhythmias (complete heart block, ventricular fibrillation, asystole), Outcome 2: Significant dysrrythmias (complete heart block, ventricular fibrillation or asystole) | ||||
| 3.2.1 Complete heart block | 1 | 208 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.32 [0.12, 0.84] |
| 3.2.2 Ventricular fibrillation | 1 | 208 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.78 [0.36, 1.71] |
| 3.2.3 Asystole | 1 | 208 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.73 [0.34, 1.56] |
| 3.3 Overall best case Show forest plot | 1 | 221 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.51 [0.34, 0.77] |
| Analysis 3.3  Comparison 3: Significant dysrhythmias (complete heart block, ventricular fibrillation, asystole), Outcome 3: Overall best case | ||||
| 3.4 Overall worst case Show forest plot | 1 | 221 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.73 [0.50, 1.06] |
| Analysis 3.4  Comparison 3: Significant dysrhythmias (complete heart block, ventricular fibrillation, asystole), Outcome 4: Overall worst case | ||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 4.1 Time to relief of pain Show forest plot | 1 | 81 | Mean Difference (IV, Fixed, 95% CI) | ‐353.00 [‐487.55, ‐218.45] |
| Analysis 4.1  Comparison 4: Time to pain relief, Outcome 1: Time to relief of pain | ||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 5.1 12 hour Plasma Creatine Phosphokinase Show forest plot | 1 | 84 | Mean Difference (IV, Fixed, 95% CI) | ‐138.00 [‐843.83, 567.83] |
| Analysis 5.1  Comparison 5: Magnitude of cardiac enzyme changes, Outcome 1: 12 hour Plasma Creatine Phosphokinase | ||||
| 5.2 24 hour Plasma Creatine Phosphate Show forest plot | 1 | 72 | Mean Difference (IV, Fixed, 95% CI) | ‐65.00 [‐530.96, 400.96] |
| Analysis 5.2  Comparison 5: Magnitude of cardiac enzyme changes, Outcome 2: 24 hour Plasma Creatine Phosphate | ||||
| 5.3 Maximum Plasma Creatine Phosphate Show forest plot | 2 | 184 | Mean Difference (IV, Fixed, 95% CI) | ‐493.16 [‐838.74, ‐147.58] |
| Analysis 5.3  Comparison 5: Magnitude of cardiac enzyme changes, Outcome 3: Maximum Plasma Creatine Phosphate | ||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 6.1 Improved contraction in at least one segment (post‐HBOT echo) Show forest plot | 1 | 34 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.09 [0.01, 1.40] |
| Analysis 6.1  Comparison 6: Improvement in left ventricular function, Outcome 1: Improved contraction in at least one segment (post‐HBOT echo) | ||||
| 6.2 Left Ventricular Ejection Fraction‐ % (final estimate) Show forest plot | 2 | 190 | Mean Difference (IV, Random, 95% CI) | 5.47 [2.19, 8.75] |
| Analysis 6.2  Comparison 6: Improvement in left ventricular function, Outcome 2: Left Ventricular Ejection Fraction‐ % (final estimate) | ||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 7.1 Overall length of stay (days) Show forest plot | 1 | 64 | Mean Difference (IV, Fixed, 95% CI) | ‐1.80 [‐3.70, 0.10] |
| Analysis 7.1  Comparison 7: Length of Stay, Outcome 1: Overall length of stay (days) | ||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 8.1 Total adverse events Show forest plot | 3 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| Analysis 8.1  Comparison 8: Adverse events of therapy, Outcome 1: Total adverse events | ||||
| 8.1.1 Tympanic membrane rupture | 2 | 269 | Risk Ratio (M‐H, Fixed, 95% CI) | 4.56 [0.19, 107.54] |
| 8.1.2 Acute neurological oxygen toxicity | 2 | 274 | Risk Ratio (M‐H, Fixed, 95% CI) | Not estimable |
| 8.1.3 Claustrophobia | 1 | 208 | Risk Ratio (M‐H, Fixed, 95% CI) | 31.60 [1.92, 521.22] |
Study flow diagram
Forest plot of comparison: 1 Death, outcome: 1.1 Death at any time.
Comparison 1: Death, Outcome 1: Death at any time
Comparison 1: Death, Outcome 2: Death ‐ best case scenario
Comparison 1: Death, Outcome 3: Death ‐ worst case scenario
Comparison 2: Major Adverse Cardiac Events, Outcome 1: Major Adverse Cardiac Events
Comparison 2: Major Adverse Cardiac Events, Outcome 2: MACE ‐ Best case scenario
Comparison 2: Major Adverse Cardiac Events, Outcome 3: MACE ‐ worst case scenario
Comparison 2: Major Adverse Cardiac Events, Outcome 4: Recurrent acute myocardial infarction (AMI)
Comparison 2: Major Adverse Cardiac Events, Outcome 5: Recurrent AMI ‐ best case scenario
Comparison 2: Major Adverse Cardiac Events, Outcome 6: Recurrent AMI ‐ Worst case scenario
Comparison 3: Significant dysrhythmias (complete heart block, ventricular fibrillation, asystole), Outcome 1: Overall (CHB, VF and asystole combined)
Comparison 3: Significant dysrhythmias (complete heart block, ventricular fibrillation, asystole), Outcome 2: Significant dysrrythmias (complete heart block, ventricular fibrillation or asystole)
Comparison 3: Significant dysrhythmias (complete heart block, ventricular fibrillation, asystole), Outcome 3: Overall best case
Comparison 3: Significant dysrhythmias (complete heart block, ventricular fibrillation, asystole), Outcome 4: Overall worst case
Comparison 4: Time to pain relief, Outcome 1: Time to relief of pain
Comparison 5: Magnitude of cardiac enzyme changes, Outcome 1: 12 hour Plasma Creatine Phosphokinase
Comparison 5: Magnitude of cardiac enzyme changes, Outcome 2: 24 hour Plasma Creatine Phosphate
Comparison 5: Magnitude of cardiac enzyme changes, Outcome 3: Maximum Plasma Creatine Phosphate
Comparison 6: Improvement in left ventricular function, Outcome 1: Improved contraction in at least one segment (post‐HBOT echo)
Comparison 6: Improvement in left ventricular function, Outcome 2: Left Ventricular Ejection Fraction‐ % (final estimate)
Comparison 7: Length of Stay, Outcome 1: Overall length of stay (days)
Comparison 8: Adverse events of therapy, Outcome 1: Total adverse events
| hyperbaric oxygen therapy for acute coronary syndrome | ||||||
| Patient or population: patients with acute coronary syndrome | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | No of Participants | Quality of the evidence | Comments | |
|---|---|---|---|---|---|---|
| Assumed risk | Corresponding risk | |||||
| Control | hyperbaric oxygen therapy | |||||
| Death at any time | Study population | RR 0.58 | 614 | ⊕⊕⊝⊝ | ||
| 116 per 1000 | 67 per 1000 | |||||
| Medium risk population | ||||||
| 102 per 1000 | 59 per 1000 | |||||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group grades of evidence | ||||||
| 1 Critical outcome | ||||||
| hyperbaric oxygen therapy for acute coronary syndrome | ||||||
| Patient or population: patients with acute coronary syndrome | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | No of Participants | Quality of the evidence | Comments | |
|---|---|---|---|---|---|---|
| Assumed risk | Corresponding risk | |||||
| Control | hyperbaric oxygen therapy | |||||
| 12 hour Plasma Creatine Phosphokinase | The mean 12 hour Plasma Creatine Phosphokinase in the intervention groups was | 84 | ⊕⊕⊕⊝ | |||
| 24 hour Plasma Creatine Phosphate | The mean 24 hour Plasma Creatine Phosphate in the intervention groups was | 72 | ⊕⊕⊕⊝ | |||
| Maximum Plasma Creatine Phosphate | The mean Maximum Plasma Creatine Phosphate in the intervention groups was | 184 | ⊕⊕⊕⊕ | |||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group grades of evidence | ||||||
| 1 Single trial only | ||||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1.1 Death at any time Show forest plot | 5 | 614 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.58 [0.36, 0.92] |
| 1.1.1 Subjects presenting in cardiogenic shock | 1 | 12 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.61 [0.32, 1.18] |
| 1.1.2 Subjects presenting without cardiogenic shock | 5 | 602 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.57 [0.33, 0.98] |
| 1.2 Death ‐ best case scenario Show forest plot | 5 | 617 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.37 [0.23, 0.58] |
| 1.3 Death ‐ worst case scenario Show forest plot | 5 | 617 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.34 [0.91, 1.96] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 2.1 Major Adverse Cardiac Events Show forest plot | 1 | 61 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.12 [0.02, 0.85] |
| 2.2 MACE ‐ Best case scenario Show forest plot | 1 | 69 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.09 [0.01, 0.61] |
| 2.3 MACE ‐ worst case scenario Show forest plot | 1 | 69 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.56 [0.23, 1.40] |
| 2.4 Recurrent acute myocardial infarction (AMI) Show forest plot | 1 | 129 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.28 [0.08, 0.95] |
| 2.5 Recurrent AMI ‐ best case scenario Show forest plot | 1 | 129 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.17 [0.05, 0.55] |
| 2.6 Recurrent AMI ‐ Worst case scenario Show forest plot | 1 | 129 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.92 [0.42, 2.02] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 3.1 Overall (CHB, VF and asystole combined) Show forest plot | 1 | 208 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.59 [0.39, 0.89] |
| 3.2 Significant dysrrythmias (complete heart block, ventricular fibrillation or asystole) Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 3.2.1 Complete heart block | 1 | 208 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.32 [0.12, 0.84] |
| 3.2.2 Ventricular fibrillation | 1 | 208 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.78 [0.36, 1.71] |
| 3.2.3 Asystole | 1 | 208 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.73 [0.34, 1.56] |
| 3.3 Overall best case Show forest plot | 1 | 221 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.51 [0.34, 0.77] |
| 3.4 Overall worst case Show forest plot | 1 | 221 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.73 [0.50, 1.06] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 4.1 Time to relief of pain Show forest plot | 1 | 81 | Mean Difference (IV, Fixed, 95% CI) | ‐353.00 [‐487.55, ‐218.45] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 5.1 12 hour Plasma Creatine Phosphokinase Show forest plot | 1 | 84 | Mean Difference (IV, Fixed, 95% CI) | ‐138.00 [‐843.83, 567.83] |
| 5.2 24 hour Plasma Creatine Phosphate Show forest plot | 1 | 72 | Mean Difference (IV, Fixed, 95% CI) | ‐65.00 [‐530.96, 400.96] |
| 5.3 Maximum Plasma Creatine Phosphate Show forest plot | 2 | 184 | Mean Difference (IV, Fixed, 95% CI) | ‐493.16 [‐838.74, ‐147.58] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 6.1 Improved contraction in at least one segment (post‐HBOT echo) Show forest plot | 1 | 34 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.09 [0.01, 1.40] |
| 6.2 Left Ventricular Ejection Fraction‐ % (final estimate) Show forest plot | 2 | 190 | Mean Difference (IV, Random, 95% CI) | 5.47 [2.19, 8.75] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 7.1 Overall length of stay (days) Show forest plot | 1 | 64 | Mean Difference (IV, Fixed, 95% CI) | ‐1.80 [‐3.70, 0.10] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 8.1 Total adverse events Show forest plot | 3 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 8.1.1 Tympanic membrane rupture | 2 | 269 | Risk Ratio (M‐H, Fixed, 95% CI) | 4.56 [0.19, 107.54] |
| 8.1.2 Acute neurological oxygen toxicity | 2 | 274 | Risk Ratio (M‐H, Fixed, 95% CI) | Not estimable |
| 8.1.3 Claustrophobia | 1 | 208 | Risk Ratio (M‐H, Fixed, 95% CI) | 31.60 [1.92, 521.22] |
