Reviving High-Dose Oxygen Therapy After Stroke

Let's just try and push a little more oxygen into the brain.

Stroke stops cerebral perfusion. A penumbra of varying size around the affected tissue remains salvageable, and, in theory, a little bit of extra oxygen might prevent subsequent deterioration.

A little bit of oxygen doesn’t help.

A whole lot of oxygen doesn’t help.

Or does it?

This is about as simple an intervention as you can get, giving stroke patients 100% O2 by non-rebreather mask for four hours, a time frame spanning their arrival to hospital through endovascular intervention. A “sham” cohort received a similar apparent oxygen delivery, but with the mask side ports open to allow air mixing.

The pilot OPENS-1 demonstrated positive results. Here’s the key figure from OPENS-2, tucked away in the supplemental content:

Seems like a reasonable result – and a low-cost, minimal-downside intervention. However, with the prior literature littered with failure, these results cannot be considered reliable. It would be reasonable to a) wait for independent confirmation, or b) roll out the intervention in a quasi-experimental structure with the ability to measure any potential treatment effect.

The next work from these authors moves on to intravenous thrombolysis in OPENS-3, currently enrolling.