Hyperbaric Oxygen Therapy for Crush Injuries
HBOT is an FDA-approved treatment for crush injuries. Learn how it reduces reperfusion damage, limits swelling, and helps preserve injured tissue.
Hyperbaric Oxygen Therapy for Crush Injuries
Crush injuries create two waves of damage. The first comes from the compression itself. The second happens when blood flow returns. HBOT is an FDA-approved adjunct that targets both, and it works best when started as early as possible.
What Crush Injuries Are
A crush injury happens when a body part is compressed by high force — common in industrial accidents, vehicle crashes, structural collapses, and heavy machinery incidents.
The damage comes from two sources. Direct compression tears and destroys tissue immediately. Reperfusion injury comes after: when blood flow is restored to compressed tissue, it triggers a burst of free radical damage that can kill cells that survived the initial crush.
Crush injuries can also cause compartment syndrome — dangerous pressure buildup inside muscle compartments that cuts off circulation and causes further tissue death. This is a surgical emergency.
The treatment goal is to preserve as much viable tissue as possible and prevent amputation.
How HBOT Helps
HBOT works on several mechanisms that are specific to crush injuries.
It reduces reperfusion injury. By saturating tissue with oxygen under pressure, HBOT blunts the free radical burst that damages cells when circulation is restored. It also inhibits the attachment of white blood cells to blood vessel walls — the inflammatory response that causes additional vascular damage during reperfusion.
It reduces edema. Excess swelling inside compartments worsens the injury and can push a borderline compartment syndrome into a surgical emergency. HBOT has a documented effect on reducing tissue swelling.
It delivers dissolved oxygen directly to marginally viable tissue that isn’t getting enough through impaired circulation. This is the same mechanism it uses in other hypoxic wound conditions.
Treatment starts fast — often within hours of the injury — to maximize tissue salvage.
What the Research Shows
Bouachour and colleagues (1996) conducted a randomized double-blind placebo-controlled trial of HBOT for crush injuries. The study found HBOT significantly improved complete tissue healing rates compared to placebo. PMID: 8786563. This is one of the few randomized controlled trials in the HBOT literature and is widely cited as the primary evidence for this indication.
The FDA and the Undersea and Hyperbaric Medical Society list crush injuries among approved HBOT indications.
When HBOT Is Part of Treatment
Not every crush injury patient needs HBOT. Severity and the extent of marginally viable tissue determine candidacy. A trauma surgeon and hyperbaric medicine physician evaluate together.
One practical challenge is availability. Not every trauma center has a hyperbaric chamber on site. For patients who qualify, a transfer to a facility with hyperbaric capability may be arranged, depending on medical stability.
Typical protocols run 10 to 20 sessions at 2.0 to 2.4 ATA, often daily in the acute phase. The number of sessions depends on injury severity and tissue response.
For related conditions, see the pages on osteomyelitis and non-healing wounds. To understand more about the treatment itself, read what is HBOT. For cost and coverage information, see the cost guide and the insurance guide.
FAQ
Is HBOT FDA-approved for crush injuries?
Yes. Crush injuries are listed among the approved HBOT indications recognized by the FDA and the Undersea and Hyperbaric Medical Society. A 1996 randomized controlled trial by Bouachour and colleagues found HBOT significantly improved complete tissue healing compared to placebo.
How soon after a crush injury should HBOT start?
As soon as possible, often within hours of the injury. The goal is to reduce reperfusion injury and preserve marginally viable tissue before it dies. Delayed treatment reduces the amount of tissue that can be saved.
Does HBOT replace surgery for crush injuries?
No. HBOT is used alongside surgery, vascular repair, and standard trauma care. It addresses specific mechanisms of crush injury damage — reperfusion injury, swelling, and tissue hypoxia — that surgery alone doesn’t fully address.
How many HBOT sessions are needed for a crush injury?
Typical protocols run 10 to 20 sessions at 2.0 to 2.4 ATA, often daily in the acute phase. The number of sessions depends on injury severity and how the tissue responds to treatment.
References
Bouachour, G. et al. (1996). Hyperbaric oxygen therapy in the management of crush injuries: a randomized double-blind placebo-controlled clinical trial. PMID: 8786563. https://pubmed.ncbi.nlm.nih.gov/8786563/
Medical Disclaimer: This page is for informational purposes only. It does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider before pursuing any medical treatment.