Meta analysis of hyperbaric oxygen combined with edaravone in the treatment of delayed encephalopathy after acute carbon monoxide poisoning

Objective To evaluate systematically the effects and safety of edaravone combined with HBO in the treatment of delayed encephalopathy after acute carbon monoxide poisoning(DEACMP). Methods A computer-aided information retrieval was made by using databases including PubMed, Cochrane Library, EMbase, Lancet, CBM, CNKI, VIP and WanFang Academic Journals Database from the inception to November 2015, and related data were also collected from those published and unpublished sources. The 2 reviewers were recruited to screen and select related literature independently in accordance with the literature selection criteria and exclusion criteria. Then, after evaluation of the quality of included literature, meta-analysis was made by using RevMan5.1 software. Results Finally, a total of 23 randomized control trials(RCTs)involving 1 494 patients were included in the study. The results of meta-analyses indicated that the therapeutic effects of edaravone combined with HBO on the patients of the combined group were[OR=4.31, 95%CI(3.15, 5.91)](P<0.01), its curative effects were[OR=1.91, 95%CI(1.48, 2.47)](P<0.01), and HDS scores after treatment were[SMD=2.22, 95%CI(1.26, 3.19)]14 days after treatment(P<0.01). Thirty days after treatment, standard measurement deviation(SMD)= 3.46, 95%CI(2.75, 4.16)(P<0.001). The serum levels of MDA after treatment increased[SMD=0.32, 95%CI(0.03, 0.61)], 2 weeks after treatment(P<0.05); SMD=0.52, 95%CI(0.16, 0.88)3 weeks after treatment(P<0.01); SMD=0.81, 95%CI(0.51, 1.11)4 weeks after treatment(P<0.01), which were all superior to those of the HBO group, and statistical significance be seen, when comparisons were made between them(P<0.01). Conclusions Evidence showed that the therapeutic effects of edaravone combined with HBO in the treatment of DEACMP were obviously superior to those by HBO therapy alone. Clinicians could adopt more rational and effective treatment regimen accordingly. Key words: Hyperbaric oxygen; Edaravone; Delayed encephalopathy after acute carbon monoxide poisoning; Systematic review; Randomized control trial