O-085 - THE EFFICACY OF HEMOGLOBIN SPRAY IN WOUND MANAGEMENT: A SYSTEMATIC REVIEW AND NETWORK META-ANALYSIS OF COMPARATIVE STUDIES

TOPIC:
Wound healing
AUTHORS:
Wilasrusmee C. (Department of Surgery, Faculty of Medicaine Ramathibodi Hospital, Mahidol University ~ Bangkok ~ Thailand) , Poprom N. (Department of Surgery, Faculty of Medicaine Ramathibodi Hospital, Mahidol University ~ Bangkok ~ Thailand) , Supsamutchaia C. (Department of Surgery, Faculty of Medicaine Ramathibodi Hospital, Mahidol University ~ Bangkok ~ Thailand) , Pornwaragorn C. (Department of Surgery, Faculty of Medicaine Ramathibodi Hospital, Mahidol University ~ Bangkok ~ Thailand) , Horsirimanont S. (Department of Surgery, Faculty of Medicaine Ramathibodi Hospital, Mahidol University ~ Bangkok ~ Thailand) , Jirasiritham J. (Department of Surgery, Faculty of Medicaine Ramathibodi Hospital, Mahidol University ~ Bangkok ~ Thailand)
Introduction:
Up to 6% of the global population is affected by chronic wounds, such as venous ulcers, pressure ulcers, and diabetic foot ulcers (DFUs). Standard of care fails to heal approximately 25% of venous ulcers and 50% of DFUs. Thus, there is an unmet need for novel therapies that promote healing and provide more efficient wound care in complex, hard to heal wounds. Oxygen and adequate blood supply are essential for wound healing and are potentially effective interventions for chronic wounds. Topical hemoglobin therapy (purified hemoglobin spray) is a novel therapeutic technology approved for use in chronic wounds that binds atmospheric oxygen and improves the availability of oxygen at the wound site.
Methods:
This systematic review and network meta-analysis was conducted to compare the efficacy and safety of hemoglobin spray in the treatment of chronic wounds with that of hyperbaric oxygen therapy (HBOT). Twenty four studies (16 randomized controlled trials and eight cohort studies) met the inclusion criteria. This systematic review and NMA were conducted following the Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) guidelines and PROSPERO number: CRD42020161396.
Results:
Hemoglobin spray as adjunctive therapy was shown to have a significant beneficial effect compared with HBOT in improving the healing rate of chronic wounds, with the proportion of wound healing 2.36 and 1.62 times better than control, respectively. Hemoglobin spray was also associated with 1.32 times higher treatment success than HBOT and had a higher chance of treatment success (67.9%, surface under the cumulative ranking curve [SUCRA] = 0.8) compared with HBOT (32.1%, SUCRA = 0.7). 80% of RCTs were at low risk of bias for selective reporting (reporting bias), allocation concealment (selection bias), and incomplete outcome data (attrition bias) but about 60% of RCTs were considered at low risk for blinding of outcome assessment (detection bias). All RCTs were at unclear risk of bias for blinding of participants. The overall risk of bias was considered low for most of the cohort studies
Conclusion:
In conclusion, the evidence indicates that the proportion of wound healing with hemoglobin spray or HBOT was higher than control. Network meta-analysis demonstrated that hemoglobin spray had a higher chance of treatment success than HBOT
References:
Kranke P, Bennett MH, Martyn-St James M, Schnabel A, Debus SE, Weibel S. Hyperbaric oxygen therapy for chronic wounds. Cochrane Database Syst Rev. 2015(6):CD004123. Stoekenbroek RM, Santema TB, Legemate DA, Ubbink DT, van den Brink A, Koelemay MJ. Hyperbaric oxygen for the treatment of diabetic foot ulcers: a systematic review. Eur J Vasc Endovasc Surg. 2014;47(6):647-655. Elg F, Hunt S. Hemoglobin spray as adjunct therapy in complex wounds: Meta-analysis versus standard care alone in pooled data by wound type across three retrospective cohort controlled evaluations. SAGE Open Med. 2018;6:2050312118784313.