2019 June;49(2)

Diving Hyperb Med. 2019 June;49(2):77−78. doi: 10.28920/dhm49.2.77-78. PMID: 31177512.

Risk mitigation in divers with persistent (patent) foramen ovale

Peter Wilmshurst

Dr Peter Wilmshurst, Consultant Cardiologist, Royal Stoke University Hospital, Stoke-on-Trent, ST4 6QG, UK
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Key words
Decompression illness; Decompression sickness; Persistent (patent) foramen ovale; Atrial septal defect; Right-to-left shunt; Trans-catheter closure

In this issue, Anderson and colleagues report follow-up of divers who were found to have a persistent (patent) foramen ovale (PFO) or, in eleven cases, an atrial septal defect (ASD).1 In most divers diagnosis followed an episode of decompression illness (DCI). The efficacy of closure of the PFO/ASD in preventing future DCI was compared with conservative diving. They reported that in the closure group the occurrence of confirmed DCI decreased significantly compared with pre-closure, but in the conservative group this reduction was not significant.

 

Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.

Publication Type: Editorial


2019 June;49(2)

Diving Hyperb Med. 2019 June;49(2):80−87. doi: 10.28920/dhm49.2.80–87. PMID: 31177513.

The effectiveness of risk mitigation interventions in divers with persistent (patent) foramen ovale

George Anderson1, Douglas Ebersole2, Derek Covington3, Petar J Denoble1

1Divers Alert Network, Durham NC, USA
2Watson Clinic, Lakeland FL, USA
3Department of Anesthesiology, University of Florida, Gainesville FL, USA

Corresponding author: Petar J Denoble, Divers Alert Network, 6 West Colony Place, Durham, NC 27705, USA
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Key words
Cardiovascular; Decompression sickness; Decompression illness; Right-to-left shunt; Trans-catheter closure

Abstract
(Anderson G, Ebersole D, Covington D, Denoble PJ. The effectiveness of risk mitigation interventions in divers with persistent (patent) foramen ovale. Diving and Hyperbaric Medicine. 2019 June 30;49(2):80–87. doi: 10.28920/dhm49.2.80-87. PMID: 31177513.)
Introduction: Persistent (patent) foramen ovale (PFO) is a recognized risk for decompression sickness (DCS) in divers, which may be mitigated by conservative diving or by PFO closure. Our study aimed to compare the effectiveness of these two risk mitigation interventions.
Methods: This was a prospective study on divers who tested positive for PFO or an atrial septal defect (ASD) and either decided to continue diving without closure ('conservative group'), or to close their PFO/ASD and continue diving ('closure group'). Divers’ characteristics, medical history, history of diving and history of DCS were reported at enrollment and annually after that. The outcome measures were the incidence rate of DCS, frequency and intensity of diving activities, and adverse events of closure.
Results: Divers in both groups dived less and had a lower incidence rate of confirmed DCS than before the intervention. In the closure group (n = 42) the incidence rate of confirmed DCS decreased significantly. Divers with a large PFO experienced the greatest reduction in total DCS. In the conservative group (n = 23), the post-intervention decrease in confirmed DCS incidence rate was not significant. Of note, not all divers returned to diving after closure. Seven subjects reported mild adverse events associated with closure; one subject reported a serious adverse event.
Conclusions: PFO closure should be considered on an individual basis. In particular, individuals who are healthy, have a significant DCS burden, a large PFO or seek to pursue advanced diving may benefit from closure.

Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.

Publication Type: Original article


2019 June;49(2)

Diving Hyperb Med. 2019 June;49(2):88−95. doi: 10.28920/dhm49.2.88–95. PMID: 31177514.

Serum tau concentration after diving – an observational pilot study

Anders Rosén1, Nicklas Oscarsson2, Andreas Kvarnström1, Mikael Gennser3, Göran Sandström4, Kaj Blennow5,6, Helen Seeman-Lodding1, Henrik Zetterberg5,6,7,8

1Department of Anesthesia and Intensive Care Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
2Department of Surgery, Angered Hospital, Gothenburg
3Department of Environmental Physiology, School of Chemistry, Biotechnology and Health, Royal Institute of Technology, KTH, Stockholm, Sweden
4Swedish Armed Forces, Center for Defence Medicine, Gothenburg
5Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Gothenburg
6Department of Psychiatry and Neurochemistry, Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
7Department of Neurodegenerative Disease, UCL Institute of Neurology, London, United Kingdom
8UK Dementia Research Institute at UCL, London

Corresponding author: Anders Rosén, Department of Anesthesia and Intensive Care Medicine, Sahlgrenska University Hospital, Göteborgsvägen 31, S-431 80 Mölndal, Sweden
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Key words

Tau protein; Decompression sickness; Venous gas emboli; Diving research; Biomarkers; Central nervous system; Stress

Abstract
(Rosén A, Oscarsson N, Kvarnström , Gennser M, Sandström G, Blennow K, Seeman-Lodding H, Zetterberg H. Serum tau concentration after diving – an observational pilot study. Diving and Hyperbaric Medicine. 2019 June 30;49(2):88–95. doi: 10.28920/dhm49.2.88-95. PMID: 31177514.)
Introduction: Increased concentrations of tau protein are associated with medical conditions involving the central nervous system, such as Alzheimer’s disease, traumatic brain injury and hypoxia. Diving, by way of an elevated ambient pressure, can affect the nervous system, however it is not known whether it causes a rise in tau protein levels in serum. A prospective observational pilot study was performed to investigate changes in tau protein concentrations in serum after diving and also determine their relationship, if any, to the amount of inert gas bubbling in the venous blood.
Methods: Subjects were 10 navy divers performing one or two dives per day, increasing in depth, over four days. Maximum dive depths ranged from 52–90 metres’ sea water (msw). Air or trimix (nitrogen/oxygen/helium) was used as the breathing gas and the oxygen partial pressure did not exceed 160 kPa. Blood samples taken before the first and after the last dives were analyzed. Divers were monitored for the presence of venous gas emboli (VGE) at 10 to 15 minute intervals for up to 120 minutes using precordial Doppler ultrasound.
Results: Median tau protein before diving was 0.200 pg·mL-1 (range 0.100 to 1.10 pg·mL-1) and after diving was 0.450 pg·mL-1 (range 0.100 to 1.20 pg·mL-1; P = 0.016). Glial fibrillary acidic protein and neurofilament light protein concentrations analyzed in the same assay did not change after diving. No correlation was found between serum tau protein concentration and the amount of VGE.
Conclusion: Repeated diving to between 52–90 msw is associated with a statistically significant increase in serum tau protein concentration, which could indicate neuronal stress.

Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.

Publication Type: Original article


2019 June;49(2)

Diving Hyperb Med. 2019 June;49(2):96−106. doi: 10.28920/dhm49.2.96-106. PMID: 31177515.

A survey of scuba diving-related injuries and outcomes among French recreational divers

David Monnot1, Thierry Michot2, Emmanuel Dugrenot1, François Guerrero1, Pierre Lafère1

1 EA4324 ORPHY, Institut Brestois Santé Agro Matière, Université de Bretagne Occidentale, Brest, France
2 EA3149 LABERS, Institut Brestois des Sciences de l’Homme et de la Société, Université de Bretagne Occidentale, Brest

Corresponding author: François Guerrero, EA4324 ORPHY, 6 Av. Le Gorgeu CS 93837, 29238 Brest Cedex 3, France
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Key words

Diving incidents; Epidemiology; Barotrauma; Decompression illness; First aid; Hyperbaric oxygen therapy

Abstract
(Monnot D, Michot T, Dugrenot E, Guerrero F, Lafère P. A survey of scuba diving-related injuries and outcomes among French recreational divers. Diving and Hyperbaric Medicine. 2019 June 30;49(2):96–106. doi: 10.28920/dhm49.96-106. PMID: 31177515.)
Introduction: Few studies are available to appreciate the broad spectrum of dive-related injuries (DI), which are not limited to decompression illness (DCI) and fatalities. Studies supporting injury-management efficacy from early recognition to first-aid, final treatment and outcome are also lacking. This study aims at making an epidemiologic inventory of DI among French scuba divers.
Methods: This online, retrospective, cross-sectional survey analyzed self-reported symptoms, context of occurrence, initial response and outcome. The relationships between symptoms and diver characteristics were assessed and severity scores created from the reports.
Results: A total of 799 divers responded, of whose questionnaires 784 were sufficiently complete to be analyzed. Approximately one-third (35%) of respondents had never experienced a DI. DCI-like symptoms represent a small fraction of DIs, the most commonly reported being ear barotrauma. Self-reported symptom rates decreased with increasing age and male sex. The ranking dive leader was the primary care provider in 58% of reports and 32% of injured divers never sought help. Management decisions (first aid and/or hyperbaric oxygen treatment) were related to the severity score. Complete resolution was achieved in 84 (74%) of 114 DCI cases, whilst mild (n = 22, 19%) and severe (n = 8, 7%) residual symptoms were reported. One in 10 divers who did not seek treatment for symptoms believed to be related to DCI declared some residual symptoms.
Conclusion: Based on these results, diving injury rates may be higher than previously reported. However, the most frequent symptoms appear to be of only a modest nature.

Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.

Publication Type: Original article


2019 June;49(2)

Diving Hyperb Med. 2019 June;49(2):107−111. doi: 10.28920/dhm49.2.107-111. PMID: 31177516.

The impact of health on professional diver attrition

Chris Sames1, Desmond F Gorman2, Simon J Mitchell3, Lifeng Zhou4

1 Slark Hyperbaric Unit, Waitemata District Health Board, Auckland, New Zealand
2 Department of Medicine, University of Auckland, Auckland
3 Department of Anaesthesiology, University of Auckland
4 Funding and Outcomes, Waitemata and Auckland District Health Boards, Auckland

Corresponding author: Chris Sames, Slark Hyperbaric Unit, Waitemata District Health Board, Stanley Point, Auckland 0624, New Zealand
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Key words

Occupational diving; Occupational health; Diving industry; Diving at work; Medicals – diving; Smoking; Medical database

Abstract
(Sames C, Gorman DF, Mitchell SJ, Zhou L. The impact of health on professional diver attrition. Diving and Hyperbaric Medicine. 2019 June 30;49(2):107–111. doi: 10.28920/dhm49.2.107-111. PMID: 31177516.)
Introduction: Approximately 77% of professional divers leave the industry within five years of entry for reasons that are uncertain. One possibility is that attrition is due to ill-health. The health of New Zealand occupational divers is surveyed by a comprehensive medical examination every five years and by a health questionnaire in the intervening years. Divers are thereby confirmed ‘fit’ annually. The aim of this study was to determine if divers quit the industry due to a health problem not identified by this health surveillance system.
Method: 601 divers who had left the industry within five years of entry medical examination (‘quitters’) were identified from a computerised database. One hundred and thirty-six who could be contacted were questioned about their principal reason for quitting. Comparison was made between the health data of all those defined as ‘quitters’ and a group of 436 ‘stayers’ who have remained active in the industry for over 10 years.
Results: Health was the principal reason for abandoning a diving career for only 2.9% of quitters. The overwhelming majority (97.1%) quit because of dissatisfaction with aspects of the work, such as remuneration and reliability of employment. Besides gender, the only significant difference between the health data of quitters and stayers was that smoking was four times more prevalent among quitters.
Conclusions: The key determinant of early attrition from the New Zealand professional diver workforce is industry-related rather than health-related. The current New Zealand diver health surveillance system detects the medical problems that cause divers to quit the industry.

Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.

Publication Type: Original article


2019 June;49(2)

Diving Hyperb Med. 2019 June;49(2):112−118. doi: 10.28920/dhm49.2.112-118. PMID: 31177517.

The utility and safety of hypoxia experiences for rebreather divers

Simon J Mitchell1,2, Hayden M Green3, Stacey A Reading3, Nicholas Gant3

1 Department of Anaesthesiology, University of Auckland, Auckland, New Zealand
2 Department of Anaesthesia, Auckland City Hospital, Auckland
3 Department of Exercise Sciences, University of Auckland

Corresponding author: Associate Professor Nicholas Gant, Department of Exercise Sciences, University of Auckland, Private Bag 92019, Auckland, New Zealand
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Key words

Diving; Aviation; Brain; Near infrared spectroscopy; Performance; Training; Oximetry

Abstract
(Mitchell SJ, Green HM, Reading SA, Gant N. The utility and safety of hypoxia experiences for rebreather divers. Diving and Hyperbaric Medicine. 2019 June 30;49(2):112–118. doi: 10.28920/dhm49.2.112-118. PMID: 31177517.)
Background: Aircrew training often includes an hypoxic experience aimed at improving symptom recognition and self-rescue in a subsequent hypoxic event. Similar training has been advocated for rebreather divers. We investigated the effect of a prior hypoxic experience on actual and perceived cognitive function during subsequent hypoxia and measured the physiological responses to severe progressive hypoxia.
Methods: Twenty-five subjects underwent two hypoxic hypoxia experiences (trials one and two) approximately five weeks apart. Subjects breathed 5.5% oxygen whilst performing a playing card recognition test. The primary endpoint was the time taken to make three consecutive errors in the card recognition test (time of useful consciousness, TUC). Secondary endpoints were the total number of errors made, accuracy of error recollection and physiological variables.
Results: Mean (SD) TUC was 166 seconds (37) and 169 s (35), and subjects made 8.9 (2.4) and 7.8 (2.0) errors in trials one and two respectively. Error recall was identical between trials with participants failing to recall 6 (3) and 6 (2) errors made in trials one and two respectively. Across both trials mean nadir arterial blood and cerebral oxygen saturations were 52% and 49% respectively. The mean (SD) increase in heart rate was 42 (16) beats∙min-1.
Conclusion: An hypoxic experience did not improve cognitive performance or subject insight into performance in a second exposure five weeks later. Hypoxia imposes a significant physiological stress which may be hazardous in unscreened, non-medically supervised subjects. Hypoxia experience training is not recommended for rebreather divers at this time.

Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.

Publication Type: Original article


2019 June;49(2)

Diving Hyperb Med. 2019 June;49(2):119−126. doi: 10.28920/dhm49.2.119-126. PMID: 31177518.

Early detection of diving-related cognitive impairment of different nitrogen-oxygen gas mixtures using critical flicker fusion frequency

Pierre Lafère1,2,3, Walter Hemelryck1,3, Peter Germonpré1,4, Lyubisa Matity5, François Guerrero1,2, Costantino Balestra1,3,6,7,8

1 DAN Europe Research Division, Roseto, Italy
2 Laboratoire ORPHY, EA 4324, UFR sciences et techniques, Université de Bretagne Occidentale, Brest, France
3 Environmental, Occupational, Ageing (Integrative) Physiology Laboratory, Haute Ecole Bruxelles-Brabant (HE2B), Brussels, Belgium
4 Centre for Hyperbaric Oxygen Therapy, Military Hospital 'Queen Astrid', Brussels
5 Hyperbaric Unit, Mater Dei Hospital, Msida, Malta
6 Anatomical Research and Clinical Studies (ARCS), Vrije Universiteit Brussel (V.U.B.), Brussels
7 Anatomical Research Training and Education (ARTE), Vrije Universiteit Brussel (V.U.B.)
8 Motor Sciences, Université Libre De Bruxelles (U.L.B.), Brussels

Corresponding author: Pierre Lafère, Laboratoire ORPHY, EA 4324, UFR sciences et techniques, Université de Bretagne Occidentale, 6 Avenue Le Gorgeu - CS 93837, 29238 Brest Cedex 3, France
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Key words

Enriched air – nitrox; Narcosis; Oxygen; Risk management; Near-infrared spectroscopy

Abstract
(Lafère P, Hemelryk W, Germonpré P, Matity L, Guerrero F, Balestra C. Early detection of diving-related cognitive impairment of different nitrogen-oxygen gas mixtures using critical flicker fusion frequency. Diving and Hyperbaric Medicine. 2019 June 30:49(2):119–126. doi: 10.28920/dhm49.2.119-126. PMID: 31177518.)
Introduction: Cognitive impairment related to inert gas narcosis (IGN) is a threat to diving safety and operations at depth that might be reduced by using enriched air nitrox (EANx) mixtures. Using critical flicker fusion frequency (CFFF), a possible early detection of cognitive abilities/cerebral arousal impairment when breathing different oxygen (O2) fractions was investigated.
Methods: Eight male volunteers performed, in random order, two dry chamber dives breathing either air or EANx40 (40% O2−60% nitrogen) for 20 minutes (min) at 0.4 MPa. Cognition and arousal were assessed before the dive; upon arrival at 0.4 MPa; after 15 min exposure at 0.4 MPa; on surfacing and 30 min post-dive using behavioural computer-based testing psychology experiment building language (PEBL) and by CFFF while continuously recording brain oxygenation with near-infrared spectroscopy.
Results: In both breathing conditions, CFFF and PEBL demonstrated a significant inverse correlation (Pearson r of -0.90, P < 0.0001), improved cognitive abilities/cerebral arousal occurred upon arrival at 0.4 MPa followed by a progressive deterioration. Initial brain activation was associated with a significant increase in oxyhaemoglobin (HbO2) and a simultaneous decrease of deoxyhaemoglobin (HHb). The magnitude of the changes was significantly greater under EANx (P = 0.038).
Conclusions: Since changes were not related to haemodynamic variables, HbO2 and HHb values indicate a significant, O2-dependent activation in the prefrontal cortex. Owing to the correlation with some tests from the PEBL, CFFF could be a convenient measure of cognitive performance/ability in extreme environments, likely under the direct influence of oxygen partial pressure, a potent modulator of IGN symptoms.

Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.

Publication Type: Original article


2019 June;49(2)

Diving Hyperb Med. 2019 June;49(2):127−136. doi: 10.28920/dhm49.2.127-136. PMID: 31177519.

Systematic review on the effects of medication under hyperbaric conditions: consequences for the diver

Erik Hoencamp1, Thijs TCF van Dongen2,3, Pieter-Jan AM van Ooij4, Thijs T Wingelaar4, Mees L Vervelde5, Dave AA Koch4, Rob A van Hulst4,6, Rigo Hoencamp2,3,7

1 Institute of Psychology, Leiden University, Leiden, The Netherlands
2 Defense Healthcare Organization, Ministry of Defense, Utrecht, The Netherlands
3 Department of Surgery, Alrijne Hospital, Leiderdorp, The Netherlands
4 Diving Medical Center, Royal Netherlands Navy, Den Helder, The Netherlands
5 Central Military Hospital, Ministry of Defense, Utrecht
6 Department of Anesthesiology, Academic Medical Center, Amsterdam, The Netherlands
7 Division of Surgery, Leiden University Medical Center, Leiden

Corresponding author: Thijs TCF van Dongen, Department of Surgery, Alrijne Hospital, PO Box 4220, 2350 CC Leiderdorp, Simon Smitweg 1, 2353 GA Leiderdorp, The Netherlands
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Key words

Diving; Drugs; Pharmacokinetics; Decompression sickness; Fitness to dive; Review article

Abstract
(Hoencamp E, van Dongen TTCF, van Ooij PJAM, Wingelaar TT, Vervelde ML, Koch DAA, van Hulst RA, Hoencamp R. Systematic review on the effects of medication under hyperbaric conditions: consequences for the diver. Diving and Hyperbaric Medicine. 2019 June 30;49(2):127–136. doi: 10.28920/dhm49.2.127-136. PMID: 31177519.)
Background: Physiological changes are induced by immersion, swimming and using diving equipment. Divers must be fit to dive. Using medication may impact the capacity to adapt to hyperbaric conditions. The aim of this systematic review is to assess the interaction of diving/hyperbaric conditions and medication and to provide basic heuristics to support decision making regarding fitness to dive in medicated divers.
Methods: This was a systematic review of human and animal studies of medications in the hyperbaric environment. Studies were subdivided into those describing a medication/hyperbaric environment interaction and those concerned with prevention of diving disorders. Studies without a relation to diving with compressed air, and those concerning oxygen toxicity, hyperbaric oxygen therapy or the treatment of decompression sickness were excluded.
Results: Forty-four studies matched the inclusion criteria. Animal studies revealed that diazepam and valproate gave limited protection against the onset of the high-pressure neurological syndrome. Lithium had a protective effect against nitrogen-narcosis and losartan reduced cardiac changes in repetitive diving. Human studies showed no beneficial or dangerous pressure-related interactions. In prevention of diving disorders, pseudoephedrine reduced otic barotrauma, vitamins C and E reduced endothelial dysfunction after bounce diving and hepatic oxidative stress in saturation diving.
Discussion and conclusions: Animal studies revealed that psycho-pharmaceuticals can limit the onset of neurologic symptoms and cardiovascular protective drugs might add a potential protective effect against decompression sickness. No evidence of significant risks due to changes in pharmacologic mechanisms were revealed and most medication is not a contraindication to diving. For improving decision making in prescribing medicine for recreational and occupational divers and to enhance safety by increasing our understanding of pharmacology in hyperbaric conditions, future research should focus on controlled human studies.

Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.

Publication Type: Review article


2019 June;49(2)

Diving Hyperb Med. 2019 June;49(2):137−140. doi: 10.28920/dhm49.2.137-140. PMID: 31177520.

The Hyperbaric Protective Tube: A housing for a left ventricular assist device (LVAD) in a multiplace hyperbaric chamber

Jacek Kot1,3, Piotr Siondalski2, Ewa Lenkiewicz3

1National Centre of Hyperbaric Medicine in Gdynia, Medical University of Gdansk, Gdynia, Poland
2Department of Cardiac Surgery, Medical University of Gdansk
3Department of Hyperbaric Medicine and Sea Rescue, University Centre for Maritime and Tropical Medicine, Gdynia, Poland

Corresponding author: Jacek Kot, National Centre of Hyperbaric Medicine in Gdynia, Medical University of Gdansk, Poland
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Key words

Hyperbaric oxygen therapy (HBOT); Medical devices; Safety; Risk factors; Case reports

Abstract
(Kot J, Siodalski P, Lenkiewicz E. The Hyperbaric Protective Tube: A housing for a left ventricular assist device (LVAD) in a multiplace hyperbaric chamber. Diving and Hyperbaric Medicine. 2019 June 30;49(2):137–140. doi: 10.28920/dhm49.2.137-140. PMID: 31177520.)
Introduction: During a hyperbaric oxygen therapy (HBOT) session, every medical device that is used within the hyperbaric chamber is exposed to several hazards, including an increased ambient pressure and partial pressure of oxygen. In Europe, all medical devices marketed and/or sold for use in hyperbaric conditions must be tested by the manufacturer and marked ‘CE’ if approved. At the moment, no left ventricular assist device (LVAD) has been formally approved and CE-marked for HBOT.
Case: A 65-year-old male was referred to our Hyperbaric Centre for HBOT due to a persistent life-threating soft tissue infection of the non-removable wire connecting the external controller with the pump implanted into the left ventricle of the heart (Heartware LVAD). The aim of the intervention reported here was to safely conduct HBOT sessions with this non-CE marked medical device. After risk analysis, the decision was made to isolate the external part of the LVAD (controller and batteries) from the ambient conditions in the hyperbaric chamber by placing it in a pressure-resistant housing that was vented to the external atmosphere. The housing, a 'Hyperbaric Protective Tube' was built and tested, and the resulting operating procedures were practiced by personnel involved in the patient’s care. Thirty uneventful HBOT standard sessions were conducted with subsequent clinical improvement of the soft tissue infection, resulting in an extended timeframe for awaiting heart transplantation.
Conclusion: An isolation housing that vents into the dumping system of the hyperbaric chamber allows for the safe use of critical medical devices without prior testing for their compatibility with the hyperbaric environment.

Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.

Publication Type: Technical report


Diving Hyperb Med. 2019 June;49(2):141−144. doi: 10.28920/dhm49.2.141-144. PMID: 31177521.

Cerebral arterial gas embolism in a scuba diver with a primary lung bulla

Céline MJ Goffinet1, Graham Simpson1

1Department of Respiratory and Sleep Medicine, Cairns Hospital, Cairns, Queensland, Australia

Corresponding author: Céline MJ Goffinet, Department of Respiratory and Sleep Medicine, Cairns Hospital, PO Box 902, Cairns, Queensland 4870, Australia
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Key words

Pulmonary barotrauma; Recreational diving; Diving incidents; Case reports

Abstract


(Goffinet CMJ, Simpson G. Cerebral arterial gas embolism in a scuba diver with a primary lung bulla. Diving and Hyperbaric Medicine. 2019 June 30;49(2):141–144. doi: 10.28920/dhm49.2.141-144. PMID: 31177521.)
Primary lung bullae have been reported to cause pulmonary barotrauma and lead to cerebral arterial gas embolism (CAGE) in the context of diving; however, a lack of symptoms and often minimal radiographic findings often preclude a diagnosis of lung bullae prior to undertaking diving activity. We present the case of a healthy 27-year-old Caucasian male who presented following the second of two introductory resort dives with neurological symptoms attributable to CAGE. Investigations revealed a previously undiagnosed large primary lung bulla. This case highlights the clinical sequelae of primary lung bullae in the context of pulmonary barotrauma related to recreational diving activity.

Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.

Publication Type: Case report

Diving and Hyperbaric Medicine is indexed on MEDLINE, Science Citation Index Expanded (SciSearch®) and Embase/Scopus and complies with the International Committee of Medical Journal Editors (ICMJE) Recommendation for the Conduct, Report, Editing and Publication of Scholarly Work in Medical Journals.
Articles from 2017 are deposited in PubMed Central
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