EXTRACORPOREAL BLOOD

OXYGENATION AND OZONATION

(EBOO)

Dr Mohd Nasir Sulaiman

B.Med.Sc.,MD (Ina)
 EBOO

• Extracorporeal blood oxygenation and ozonation (EBOO)

in man. Preliminary report;
• N.Di Paolo, V.Bocci, G.Garosi, E Borreli,
A.Bravi, A.Bruci, C.Aldinucci, L. Capotondo.
• The International Journal of Artificial Organs/Vol
23/no.2.2000/pp 131-141.
EBOO
• First trial done to one of volunteered for treatment

• The volunteer underwent six treatment in 3 weeks.

• The following aspects emerged:

1. It was found possible to use heparin of 5,000u for an hour
2. Extracorporeal circulation could be performed from the
cubital veins.
3. Maximum oxygenation and hence maximum ozonation were
achieved at blood flows of 75-100 ml/mim
4. The patient felt no particular sensations during treatment
5. Treatment was followed by a sensation of well-being and
euphoria, lasting several hours.
6. No significant changes in blood chemistry or other
parameters were found.
 EBOO
• Two months after the last treatment, the volunteer
noted:
• The disappearance of two subcutaneous lipomas,
about 6 cm in diameter.
• The lipomas had be present for several years and
were in the right deltoid and left lumbar areas.
EBOO
• The finding prompted them to consider treating a male
patient with Madelung disease (age 54 years)

• The patient had a history or surgical operations to remove

lipomatous masses in various parts of the body

• Before treatment, the patient had diffuse lipomatous

masses on the arms, thighs, back, abdomen and neck.
 The patient underwent 12 treatments
(two per week for six weeks)
Before EBOO After 6 weeks After 2 months
(almost completely disappeared)
(12x EBOO)
Right Arm 40 cm 34 cm 30 cm
Left Arm 42 cm 35 cm 30 cm
Right Thigh 67 cm 53 cm 55 cm
Left Thigh 68 cm 61 cm 54 cm
Neck 48 cm 43 cm 37 cm

Weight 94.5 kg 89.2 kg 85.2 kg

No changes in routine blood chemistry and clinical parameters were found.

 EBOO

• This experience enabled them to make preliminary study of EBOO

in patients with severe disorders of lipid metabolism.

• Seven Patients were enrolled

• The patients were treated twice a week for a total of 14 sessions.

• Blood samples were taken.

EBOO- PATIENT 1,MALE, 64 YEARS
Before EBOO After EBOO
Had slight chronic kidney failure after right Echotomography of the remaining kidney
nephrectomy due to carcinoma and left was negative
superior polar nephrectomy due to
metastasis, performed 16 and 3 months
earlier, respectively

Also had diffuse histologically diagnosed Lipoma volume decreased at the end of the
lipomatosis, with small lipomas ranging in cycle. 45 days later, the lipomas had all
size from 1-3 cm. disappeared.

He suffered periodic episodes of hematuria Four months after the end of treatment,
due to papillomatosis of bladder requiring macrohematuria had not recurred
endoscopic surgery about every 4 months

Also had pain from a right hip prosthesis. Hip pain disappeared after 4 sessions and
still pain free, four monts after the end of
treatment.
 EBOO - PATIENT 2 (MALE 68 YEARS)

Both feet were affected by cholesterol embolism The patient refused more detailed examination of
after undergoing intravenous fibrinolysis with t-PA the coronaries.
for myocardial infarction.

On examination, both feet were cyanotic and the
first and second toes of the left foot presented
necrotic areas
The left foot was extremely painful, making
walking impossible and the surgeon had
suggested amputation, as is usual in such cases
after anticoagulant therapy hass proven
ineffective
After the second session, he reported a
progressive reduction in cyanosis of the feet and
formation of a scab around the necrotic area.
The scab came away at the end of the cycle and
the foot became completely functional
After the second session, patient reported
disappearance of pain.

ECG showed signs of anterior necrosis and Two monts after therapy, the ECG picture
ischemia substantially improved and remained thus at 4
months
EBOO - PATIENT 3 (FEMALE, 81 YEARS)
Had slight chronic failure (creatinine
clearance 38 ml/min) due to atherosclerotic
nephropathy.
Also had severe peripheral vasculopathy
Pain had prevented walking for about a year
A squamocellular papilloma of tonque had
been removed surgically about a month
earlier.
A general improvement in health after three
sessions and succeeded in climbing the 46
steps to his house after six sessions.
At the end of the treatment,
echocardiography had improved kinesis with
an FE of 50%
Holter dynamics showed a sharp reduction in
the number of extrasystoles per day and the
total disappearance of doublets and triplets
Well-being and ECG and ultrasonographic
improvements persisted at 4 months.
EBOO- PATIENT 4 (MALE, 60 YEARS)

Had Severe coronary disease and angina An improvement in angor symptoms from the
(stage II B 3 of Braunald) eight treatment

Medical history included myocardial

infarction, triple aorta-coronary bypass and
aggravation of the condition of native vessels
and grafts

Holter dynamic showed Polymorphic Holter dynamics showed a reduction in

extrasystole with many doublets and triplets polymorphic extrasystoles (from 8,765 per
day to 256 per day without doublets and
triplets)
EBOO- PATIENT 5 (FEMALE, 57 YEARS)

Had chronic kidney failure and had been in

dialysis for two years

Had peripheral vasculopathy.

Doppler USG showed severe circulatory Absence of pain during walking after 8
deficit which compromised walking, except sessions. Doppler ultrasound showed
with frequent rests and was unresponsive to improvement with respect to basal condition
medication
EBOO- PATIENT 6 (MALE, 58 YEARS

Had coronary disease with familial Improvement of subjective symptoms after

hypercholesterolemia, angor on slight the third session.
exertion.

And was on maximum doses of coronary He suspended coronary dilatory medication

dilating agents after the sixth session without advising them.
Four months after the cycle he is pain-free
and not taking medication
EBOO- PATIENT 7 (MALE, 55 YEARS)

Had Diabetes

Chronic Renal Failure and was undergoing

hemodialysis

The lower left leg had been amputated
because of gangrene
The right foot had a large ulcer exposing the
flexor tendons and much of the heel bone.
Marked improvement in the foot lesion after
14 sessions, with an increase in temperature
of the limb, disappearance of cyanosis,
disappearance of signs of infection and
inflammation, reduction of the area of
necrosis and appearance of granulayion
tissue around the edges of the lesion.
THEORY
• Ozone is a potent oxidant and decomposes immediately
on contact with biological fluids, producing a cascade of
reactive oxygen species (ROS) .

• It therefore cannot be measured in the blood but the

oxidation of plasma thiols (Protein Thiol Groups (PTG)) can
measure that decline with increasing ozone levels and

• in terms of increasing peroxidation measured with

thiobarbituric acid reactive substances (TBARS) in relation
to increased ozone concentrations.
THEORY
• During Therapy, PTG dan TBARS were monitored
before and after the filter.

• Lower doses do not cause peroxidation and higher

doses give excessive peroxidation
THEORY
• In the Trial, the patients were treated twice a week for a
total of 14 sessions.

• Blood samples were taken before and after the filter at the
beginning and at the end of the first session and at 30
minutes.

• The following parameters were evaluated: pH,pO2,PCO2,

base excess, hematocrit, hemoglobin, potassium, calsium
dan sodium
THEORY
• Before and After the entire treatment cycle, the following were
measured in serum serum:
• Glucose,
• Urea, Creatinine, Urid Acid
• AST, ASL, LDH, GGT,
• Total cholesterol, LDL, Triglyceride dan HDL
• Red cells, white cells, Hematocrit, Hemoglobin, Platelets
• Total proteins, PT, PTT, Fibrinogen, Apolipoprotein A, IgG, IgA,
IgM, Amylase, Lipase, Bilirubin, Alkaline phosphatase, Na, K,
Ca, Cl, Mg, Phosphorus
THEORY
• Before and after the cycle, the various tests for each
pathology were carried out.

• After the conclusion of the cycle, all patients were

examined every 15 days for 4 months, when blood
chemistry and the various specific tests were repeated
RESULTS
• No side effect, such as variations in blood pressure, were
observed during the total of 98 sessions of EBOO.

• Body Temperature and breathing were unchanged.

• None of the patients reported subjective sensations of

any kind except a feeling of well-being afterwards that
lasted several hours; some patients reported slight
euphoria and improved vision acuity.
RESULTS
• Level TBARS measured after the filter were significantly greater
than basal levels for ozone doses of 5 dan 10 ug/ml blood, a
further significant increase was observed at 15 ug/ml

• Interestingly, no significant change in TBARS levels was found

before the filter.

• It is important to note that basal levels of TBARS did not vary

significantly with respect to the first treatment, even after 7 and
14 sessions.
RESULTS
• Level PTG measured after the filter were significantly less
than basal levels for ozone doses of 5 dan 10 ug/ml blood,
a further significant decrease was recorded at 15 ug/ml

• No significant change in PTG levels was found before the

filter.

• Reassuringly, basal levels of PTG did not vary significantly

with respect to the first treatment, even after 7 and 14
sessions.
RESULTS
• Blood pH did not change significantly between the beginning and the end of each
session, whereas at 30 minutes, values measured before and after the filter showed
a significant shift towards alkalosis (p=0.02).

• The pO2 was not different from basal values at the end of sessions but there was
highly significant difference (p=0.02) between values obtained before and after the
filter at 30 minutes.

• After the filter, this pressure rose to more than 500mmHg, and was used as an index
of treatment efficiency

• The pCO2 did not show significantly differences at the end of sessions but was
significantly lower (p=0.02) after the filter.

• Base excess did not change

RESULTS
• Leucocytes, hematocrit, red cells and hemoglobin were not significantly
different before and after the filter or after sessions, whereas platelets
showed a small but significant decrease after each session (p=0.02) and
after filter (p=0.04) .

• Potassium levels were significantly higher at the end of sessions than at the
beginning (p=0.02) but were curiously lower after the filter than before
(p=0.02).

• No change in Na and Ca were found at the end of treatment or after the filter

• Blood chemistry at the end of the cycle was substantially the same as before
treatment.
EBOO treatments are performed by
withdrawing venous blood and
infusing it in an upward direction into
an oxygen-ozone gas exchange
filter, using a specialized bloodline
and computerized peristaltic pump
which controls the rate of withdrawal
Thank you

After passing through the oxygen-ozone

gas exchange filter, the treated blood is
then re-infused into the patient