2023 June;53(2) 

Diving Hyperb Med. 2023 June 30;53(2):76-84. doi: 10.28920/dhm53.1.76-84. PMID: 37365124.

Compressed gas diving fatalities in Australian waters 2014 to 2018

John Lippmann1,2,3, Christopher Lawrence4, Andrew Fock5

1 Australasian Diving Safety Foundation, Canterbury, Victoria, Australia
2 Department of Public Health and Preventive Medicine, Monash University, Victoria, Australia
3 Royal Life Saving Society Australia, Sydney, Australia
4 Statewide Forensic Medical Services, Royal Hobart Hospital, Tasmania, Australia
5 Department of Diving and Hyperbaric Medicine, The Alfred, Prahran, Victoria, Australia

Corresponding author: Dr John Lippmann, Australasian Diving Safety Foundation, PO Box 478, Canterbury, VIC 3126, Australia
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Keywords
Carbon monoxide; Cardiovascular; Diving deaths; Fitness to dive; Obesity; Scuba

Abstract
(Lippmann J, Lawrence C, Fock A. Compressed gas diving fatalities in Australian waters, 2014 to 2018. Diving and Hyperbaric Medicine. 2023 June 30;53(2):76−84. doi: 10.28920/dhm53.2.76-84. PMID: 37365124.)
Introduction: This study aimed to investigate compressed gas diving deaths in Australia from 2014–2018 and make comparison to those from 2001–2013 to identify ongoing problems and assess countermeasures.
Methods: Media reports and the National Coronial Information System were searched to identify scuba diving deaths for 2014–2018, inclusive. Data were extracted from the witness and police reports, medical histories, and autopsies. An Excel® database was created and a chain of events analysis conducted. Comparisons were made with the earlier report.
Results: Forty-two fatalities were identified, 38 using scuba and four using surface-supplied breathing apparatus involving 30 males and 12 females. The mean age of victims was 49.7 years, six years higher than the previous cohort. Fifty-four percent were obese. Six victims were unqualified, three were under instruction and at least 28 were experienced divers, significantly more than in the previous cohort. Health-related predisposing factors, predominantly obesity and cardiac-related, were identified as likely contributory to 26 incidents, and planning shortcomings to at least 22 deaths. One-third of the disabling conditions were primary drowning and one-quarter were cardiac. Three divers died subsequent to carbon monoxide poisoning and three likely from immersion pulmonary oedema.
Conclusions: Advancing age, obesity and the associated cardiac disease have become increasingly prevalent in diving fatalities and the need for appropriate assessment of fitness to dive is evident.

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

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Diving Hyperb Med. 2023 June 30;53(2):85−91. doi: 10.28920/dhm53.2.85-91. PMID: 37365125.

Effectiveness of hyperbaric chamber ventilation

Lyubisa Matity1, Francois Burman2, Jacek Kot3, Joseph Caruana4

1 Hyperbaric and Tissue Viability Unit, Gozo General Hospital, Victoria VCT 2520, Malta
2 Divers Alert Network, Durham NC, USA
3 National Centre for Hyperbaric Medicine, Medical University of Gdańsk, Poland
4 Department of Physics, University of Malta, Msida MSD 2080, Malta

Corresponding author: Dr Lyubisa Matity, Hillside, Triq Gorg Mifsud Chircop, Qormi QRM 1591, Malta
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Keywords
Carbon dioxide; Fire or explosion; Hyperbaric oxygen; Life support; Oxygen; Pressure

Abstract
(Matity L, Burman F, Kot J, Caruana J. Effectiveness of hyperbaric chamber ventilation. Diving and Hyperbaric Medicine. 2023 June 30;53(2):85−91. doi: 10.28920/dhm53.2.85-91. PMID: 37365125.)
Introduction: Hyperbaric chamber ventilation (HCV) refers to the intentional introduction of fresh gas, whether air, oxygen, or heliox, into a pressurised hyperbaric chamber in order to remove stale or otherwise compromised gas. The minimum required continuous HCV rate is usually determined by mathematical models derived from the contaminant mass balance within a well-stirred compartment. Non-uniform contaminant distribution patterns inside a hyperbaric chamber could emerge and invalidate the predictions of well-stirred models.
Methods: Contaminant distribution was investigated inside a clinical hyperbaric chamber with the aim of comparing well-stirred model predictions with the actual contaminant concentration measurements.
Results: Local ventilation effectiveness inside a clinical hyperbaric chamber may be compromised, leading to higher contaminant concentration values compared to the predictions of a mathematical model with a well-stirred assumption.
Conclusions: A well-stirred assumption in mathematical models is a useful simplification that allows reasonably accurate estimates of HCV requirements. However, local ventilation effectiveness values in a particular hyperbaric chamber might vary, with the potential for hazardous contaminant accumulation in under-ventilated zones.

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

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Diving Hyperb Med. 2023 June 30;53(2):92−99. doi: 10.28920/dhm53.2.92-99. PMID: 37365126.

Determining best practice for technical assessment of hookah surface supply diving equipment during diving fatality investigation

Darren Meehan1, David Smart1, John Lippmann2,3,4

1 Department of Diving and Hyperbaric Medicine, Royal Hobart Hospital, Hobart, Tasmania, Australia
2 Australasian Diving Safety Foundation, Victoria, Australia
3 Department of Public Health and Preventive Medicine, Monash University, Victoria, Australia
4 The Royal Lifesaving Society – Australia, Sydney, Australia

Corresponding author: Dr Darren Meehan, Department of Diving and Hyperbaric Medicine, Royal Hobart Hospital, 26 Campbell St, Hobart 7000, Tasmania, Australia
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Keywords
Diving deaths; Investigations; Surface supply breathing apparatus; SSBA

Abstract
(Meehan D, Smart D, Lippmann J. Determining best practice for technical assessment of hookah surface supply diving equipment during diving fatality investigation. Diving and Hyperbaric Medicine. 2023 June 30;53(2):92−99. doi: 10.28920/dhm53.2.92-99. PMID: 37365126.)
Introduction: This study aimed to develop a standard process and checklist for technical investigation of hookah diving equipment and apply it to Tasmanian hookah fatality investigations from the last 25 years.  
Methods: A literature search was undertaken to identify technical reports and equipment investigations associated with diving accidents. The information was assimilated to create a process and checklist for specifically assessing the hookah apparatus. The checklist was then applied in a gap analysis of Tasmanian hookah diving fatality technical reports from 1995 to 2019.
Results: As no papers specifically describing technical evaluation of hookah equipment were identified, references evaluating scuba equipment were used to create a hookah technical assessment process incorporating unique features of the hookah. Features included: owner responsibility for air quality; maintenance, function; exhaust proximity to air intake; reservoir volume; output non-return valves; line pressure; sufficiency of supply; entanglement; hose severance risk; gas supply failure and hosing attachment to the diver. Seven hookah diving deaths occurred in Tasmania (1995−2019) of which three had documented technical assessment. Gap analysis identified inconsistent structure between reports with variability in the case descriptors. Missing technical data included: overview of the hookah systems; accessories; weights; how the apparatus was worn by the diver; compressor suitability; assessment of hookah function; breathing gas output and exhaust position relative to air intake.
Conclusions: The study demonstrated a need to standardise technical reporting of hookah equipment after diving accidents. The checklist generated may serve as a resource for future hookah assessments and inform strategies for preventing future hookah accidents.

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

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Diving Hyperb Med. 2023 June 30;53(2):100−110. doi: 10.28920/dhm53.2.100-110. PMID: 37365127.

Technical validation of the EMMA capnometer under hyperbaric conditions

Alicia Tucker1, David Smart1

1 Department of Diving and Hyperbaric Medicine, Royal Hobart Hospital, Hobart, Tasmania, Australia

Corresponding author: Dr Alicia Tucker, Department of Diving and Hyperbaric Medicine, Royal Hobart Hospital, 26 Campbell St, Hobart 7000, Tasmania, Australia
ORCiD ID: 0000-0003-3578-8320
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Keywords
Carbon dioxide; Capnography; Hyperbaric oxygen treatment; Intensive care medicine; Patient monitoring

Abstract
(Tucker A, Smart D. Technical validation of the EMMA capnometer under hyperbaric conditions. Diving and Hyperbaric Medicine. 2023 June 30;53(2):100−110. doi: 10.28920/dhm53.2.100-110. PMID: 37365127.)
Introduction: End-tidal carbon dioxide (ETCO2) monitoring is essential for monitoring intubated critical care patients, yet its use in hyperbaric environments can be problematic. We postulated that the EMMA mainstream capnometer may function accurately under hyperbaric conditions.
Methods: Stage 1. The EMMA mainstream capnometer was tested at 101 kPa against a reference side-stream capnometer, Philips IntelliVue M3015B microstream, using 10 customised reference gases of various carbon dioxide (CO2) concentrations (2.47%−8.09%, or 18.5−60.7 mmHg at 101 kPa) in either air or oxygen. Stage 2. The functionality and accuracy of the EMMA capnometer was tested under hyperbaric conditions, 121–281 kPa, using the same test gases.
Results: At 101 kPa, the EMMA capnometer measured CO2 at levels lower than expected (mean of differences = -2.5 mmHg (95% CI -2.1 to -2.9, P < 0.001)). The Philips capnometer measured CO2 more closely to expected CO2 (mean of differences = -1.1 mmHg (95% CI -0.69 to -1.4, P < 0.001). Both devices demonstrated a significant linear relationship with expected CO2. The EMMA capnometer functioned up to the maximum test pressure (281 kPa).  The device over-read CO2 measurements at pressures > 141 kPa. Although variance increased at pressures in the therapeutic range for hyperbaric treatments, a significant linear relationship between expected and EMMA measured CO2 was demonstrated. The EMMA capnometer tolerated pressures to 281 kPa, but its display was limited to CO2 < 99 mmHg.
Conclusions: This study validated EMMA capnometer function to 281 kPa in the hyperbaric environment. The device over-read CO2 measurements at pressures >141 kPa, however there was a linear relationship between expected and measured CO2. The EMMA capnometer may be clinically useful for monitoring expired CO2 in patients undergoing hyperbaric oxygen treatment.

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Publication Type: Original article

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Diving Hyperb Med. 2023 June 30;53(2):111−119. doi: 10.28920/dhm53.2.111-119. PMID: 37365128.

Hyperbaric oxygen and treadmill exercise partially prevented bone loss and bone microarchitecture deterioration in ovariectomized rats

Xiaoling Peng1, Binli Gao1, Xiangxiu Wang2, Xiaohong Qin3, Mei Peng1, Xianrong Zeng1

1 Department of Hyperbaric Oxygen, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan Province, People’s Republic of China
2 Key Laboratory of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People’s Republic of China
3 Sichuan Provincial Center for Mental Health, The Center of Psychosomatic Medicine of Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China

Corresponding author: Professor Xianrong Zeng, 32# W. Sec 2, 1st Ring Rd, Chengdu City, Sichuan Province, People’s Republic of China
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Keywords
Animal model; Endocrinology; Hyperbaric oxygen treatment; Osteoporosis; Ovariectomy

Abstract
(Peng X, Gao B, Wang X, Qin X, Peng M, Zeng X. Hyperbaric oxygen and treadmill exercise partially prevented bone loss and bone microarchitecture deterioration in ovariectomized rats. Diving and Hyperbaric Medicine. 2023 June 30;53(2):111−119. doi: 10.28920/dhm53.2.111-119. PMID: 37365128.)
Introduction: Previous studies have demonstrated the beneficial effects of treadmill exercise (EX) on osteoporosis, and of hyperbaric oxygen (HBO) on osteoblast and osteoclast formation in vitro. We investigated the effects of HBO and the combination of HBO and EX on osteoporosis in ovariectomized rats.
Methods: Forty 3-month-old female Sprague-Dawley rats were randomly divided into 5 groups (n = 8): a sham control group (Control); an ovariectomy group; an ovariectomy with treadmill exercise treatment group; an ovariectomy with HBO treatment group; and an ovariectomy with HBO treatment combined with treadmill exercise group. The HBO exposures were 203 kPa, 85–90% O2, 90 min and the exercise regimen was 20 m·min-1, 40 min·day1, 5o slope. Both treatments were administered once daily, five days a week for 12 weeks until the rats were sacrificed.
Results: All three treatments (HBO, exercise, and both combined) significantly promoted the expression of the osteoblast‐related gene and oxidative metabolism-related gene (PGC-1α). They also exerted significant inhibitory effects on the osteoclast‐related mRNA expression (RANKL) and bone resorption marker CTX‐I. Additionally, exercise and the combination exercise-HBO treatment increased serum superoxide dysmutase (SOD) and sclerostin expression. No significant between-group difference was observed.
Conclusions: Hyperbaric oxygen, exercise, and the combination ameliorated bone microarchitecture deterioration and ovariectomy-induced bone loss in rats, and these inhibitory effects may be associated with the increased SOD and up-regulated PGC-1α.

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

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Diving Hyperb Med. 2023 June 30;53(2):120−128. doi: 10.28920/dhm53.2.120-128. PMID: 37365129.

How fit are military hyperbaric personnel after an asymptomatic or mild symptomatic COVID-19 infection? A retrospective study

Jan-Peter Schaap1, Margy E Zuluaga Fernandez2, Antoinette Houtkooper1, Edwin L Endert1, Pieter-Jan AM van Ooij1,3

1 Royal Netherlands Navy Diving and Submarine Medical Center, 1780 CA Den Helder, The Netherlands
2 Center for Man in Aviation, Royal Netherlands Air Force, 3769 DE Soesterberg, The Netherlands
3 Department of Pulmonary Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands

Corresponding author: Dr Pieter-Jan AM van Ooij, Royal Netherlands Navy Diving and Submarine Medical Center, 1780 CA Den Helder, The Netherlands
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Keywords
Fitness to dive; Health status; Health surveillance; Infectious diseases; Lung; Lung function; Pulmonary function

Abstract
(Schaap J-P, Zuluaga Fernandez ME, Houtkooper A, Endert EL, van Ooij P-J AM. How fit are military hyperbaric personnel after an asymptomatic or mild symptomatic COVID-19 infection? A retrospective study. Diving and Hyperbaric Medicine. 2023 June 30;53(2):120−128. doi: 10.28920/dhm53.2.120-128. PMID: 37365129.)
Introduction: In the diving community there is a special need to know if asymptomatic or mild COVID-19 disease impacts the cardiopulmonary functioning of individuals with occupational exposure to extreme environments. To date, no controlled studies have been conducted comparing COVID-19-infected hyperbaric employees and non-COVID-19-infected peers in a military setting.
Methods: Between June 2020 and June 2021, healthy, hyperbaric, military personnel aged between 18 and 54 years old, who had recovered from asymptomatic or subclinical COVID-19 disease at least one month earlier, were analysed. Non-COVID-infected peers with medical assessments during the same period were used as the control group. Somatometry, spirometry, VO2 max, and DLCO were measured for each group.
Results: No clinically relevant differences in somatometry, lung function tests, and exercise testing were found between the COVID-19 group and the controls. However, the percentage of individuals with a decrease in estimated VO2-max of 10% or more was significantly greater in the COVID group than in the control group (24 vs. 7.8%, P = 0.004).
Conclusions: After asymptomatic or mild symptomatic COVID-19 infections, military hyperbaric employees are as fit as those who had not encountered COVID-19. As this research was based on a military population, it cannot be extrapolated to a nonmilitary population. Further studies in nonmilitary populations are necessary to determine the medical relevance of the present findings.

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

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Diving Hyperb Med. 2023 June 30;53(2):129−137. doi: 10.28920/dhm53.2.129-137. PMID: 37365130.

Evaluation of a new hyperbaric oxygen ventilator during volume-controlled ventilation

Cong Wang1, Lianbi Xue1, Qiuhong Yu1, Yaling Liu1, Ziqi Ren1, Ying Liu1

1 Department of Hyperbaric Oxygen, Beijing Tiantan Hospital, Capital Medical University, Beijing, China

Corresponding author: Dr Lianbi Xue, Department of Hyperbaric Oxygen, Beijing Tiantan Hospital, Capital Medical University, A zone, No.199, Nansihuan West Road, Fengtai District, Beijing (100070)
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Keywords
Airway resistance; Intensive care; Intermittent positive-pressure ventilation; Respiratory mechanics

Abstract
(Wang C, Xue L, Yu Q, Liu Y, Ren Z, Liu Y. Evaluation of a new hyperbaric oxygen ventilator during volume-controlled ventilation. Diving and Hyperbaric Medicine. 2023 June 30;53(2):129−137. doi: 10.28920/dhm53.2.129-137. PMID: 37365130.)
Introduction: The performance of the Shangrila590 hyperbaric ventilator (Beijing Aeonmed Company, Beijing, China) was evaluated during volume-controlled ventilation.
Methods: Experiments were conducted in a multiplace hyperbaric chamber at 101, 152, 203, and 284 kPa (1.0, 1.5, 2.0 and 2.8 atmospheres absolute [atm abs]). With the ventilator in volume control ventilation (VCV) mode and connected to a test lung, comparison was made of the set tidal volume (VTset) versus delivered tidal volume (VT) and minute volume (MV) at VTset between 400 and 1,000 mL. Peak inspiratory pressure was also recorded. All measurements were made across 20 respiratory cycles.
Results: Across all ambient pressures and ventilator settings the difference between VTset and actual VT and between predicted MV and actual MV were small and clinically insignificant despite reaching statistical significance. Predictably, Ppeak increased at higher ambient pressures. With VTset 1,000 mL at 2.8 atm abs the ventilator produced significantly greater VT, MV and Ppeak.
Conclusions: This new ventilator designed for use in hyperbaric environments performs well. It provides relatively stable VT and MV during VCV with VTset from 400 mL to 800 mL at ambient pressures from 1.0 to 2.8 atm abs, as well as VTset 1,000 mL at ambient pressures from 1.0 to 2.0 atm abs.

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

Full article available here.


Diving Hyperb Med. 2023 June 30;53(2):138−141. doi: 10.28920/dhm53.2.138-141. PMID: 37365131.

Hyperbaric medicine in Canadian undergraduate medical school curriculum

Zoé Talbot1, Alex Lee1, Sylvain Boet2-7

1 Faculty of Medicine, University of Ottawa, ON, Canada
2 Francophone Affairs, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
3 Institut du Savoir Montfort, Ottawa, ON, Canada
4 Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, ON, Canada
5 Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
6 Department of Innovation in Medical Education, University of Ottawa, Ottawa, ON, Canada
7 Faculty of Education, University of Ottawa, Ottawa, ON, Canada

Corresponding author: Dr Sylvain Boet, Department of Anesthesiology and Pain Medicine and Department of Innovation in Medical Education, The Ottawa Hospital, General Campus, 501 Smyth Rd, Critical Care Wing 1401, Ottawa, K1H 8L6, Ontario, Canada
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Keywords
Education; Hyperbaric oxygen treatment; Teaching

Abstract
(Talbot Z, Lee A, Boet S. Hyperbaric medicine in Canadian undergraduate medical school curriculum. Diving and Hyperbaric Medicine. 2023 June 30;53(2):138−141. doi: 10.28920/dhm53.2.138-141. PMID: 37365131.)
Introduction: Hyperbaric oxygen treatment (HBOT) has fourteen approved indications in the management of acute and chronic diseases in various medical specialties. However, lack of physician knowledge and exposure to hyperbaric medicine may hinder the ability of patients to access this treatment option for approved indications. We aimed to determine the prevalence and nature of HBOT-related learning objectives in Canadian undergraduate medical education programs.
Methods: Pre-clerkship and clerkship learning objectives from responding Canadian medical schools’ curricula were reviewed. These were acquired through the school websites or by emailing the faculties. Descriptive statistics were used to summarise the number of hyperbaric medicine objectives taught in Canadian medical schools, and within each institution. 
Results: Learning objectives from seven of the 17 Canadian medical schools were received and reviewed. From the curriculum of the responding schools, only one objective was found to be related to hyperbaric medicine. Hyperbaric medicine was absent from the other six schools’ objectives.
Conclusions: Based on the responding Canadian medical schools, hyperbaric medicine objectives were mostly absent from undergraduate medical curricula. These findings illustrate a possible gap in HBOT education and the need for discussion regarding the design and implementation of HBOT educational initiatives in medical training.

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: Short communication

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Diving Hyperb Med. 2023 June 30;53(2):142−146. doi: 10.28920/dhm53.2.142-146. PMID: 37365132.

Rebreather Forum Four consensus statements

Simon J Mitchell1,2,3, Neal W Pollock4,5­­­­­

1 Department of Anaesthesiology, University of Auckland, Auckland, New Zealand
2 Department of Anaesthesia, Auckland City Hospital, Auckland, New Zealand
3 Slark Hyperbaric Unit, North Shore Hospital, Auckland, New Zealand
4 Department of Kinesiology, Université Laval, Québec, Canada
5 Service de médecine hyperbare, Centre de médecine de plongée du Québec, Hôtel-Dieu de Lévis, Québec, Canada

Corresponding author: Professor Simon J Mitchell, Department of Anaesthesiology, School of Medicine, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
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Keywords
Accidents; Checklists; Decompression; Education; Equipment; Safety; Technical diving; Training

Abstract

(Mitchell SJ, Pollock NW. Rebreather Forum Four consensus statements. Diving and Hyperbaric Medicine. 2023 June 30;53(2):142−146. doi: 10.28920/dhm53.2.142-146. PMID: 37365132.)
Closed circuit rebreathers have been widely adopted by technical divers as tools for reducing gas consumption and extending depth and duration capabilities. Rebreathers are technologically complex with many failure points, and their use appears associated with a higher accident rate than open circuit scuba. Rebreather Forum Four (RF4) was held in Malta in April 2023 attracting approximately 300 attendees and representatives of multiple manufacturers and training agencies. Over two and a half days a series of lectures was given by influential divers, engineers, researchers and educators on topics of contemporary relevance to rebreather diving safety. Each lecture was followed by a discussion session with audience participation. Potential consensus statements were drafted by the authors (SJM and NWP) during the course of the meeting. These were worded to be confluent with some important messages emerging from the presentations and subsequent discussions. The statements were presented one by one in a half-day plenary session of participants, and discussion was invited on each. After discussion and any necessary revision, the participants voted on whether to adopt the statement as a position of the forum. A clear majority was required for acceptance. Twenty-eight statements embracing thematic areas designated ‘safety’, ‘research’, ‘operational issues’, ‘education and training’, and ‘engineering’ were adopted. Those statements are presented along with contextualising narrative where necessary. The statements may help shape research and teaching initiatives, and research and development strategies over subsequent years.

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: Short communication

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Diving Hyperb Med. 2023 June 30;53(2):147−150. doi: 10.28920/dhm53.2.147-150. PMID: 37365133.

Successful hyperbaric oxygen treatment of a patient with a HeartMate III left ventricular assist device

Arun Ilancheran1,2, Ian Millar1,2, Theo Tsouras1

1 Hyperbaric Service, Alfred Health, Melbourne, Australia
2 Monash University, Melbourne, Australia

Corresponding author: Dr Arun Ilancheran, Hyperbaric Unit, Main Ward Block, Level 1, 55 Commercial Rd, Melbourne VIC 3004, Australia
ORCiD: 0000-0002-3341-8134
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Keywords
Bioengineering; Case report; LVAD; Haemorrhagic cystitis

Abstract

(Ilancheran A, Millar I, Tsouras T. Successful hyperbaric oxygen treatment of a patient with a HeartMate III left ventricular assist device. Diving and Hyperbaric Medicine. 2023 June 30;53(2):147−150. doi: 10.28920/dhm53.2.147-150. PMID: 37365133.)
A 53-year-old woman with a HeartMate III left ventricular assist device (LVAD) was successfully treated under hyperbaric conditions for haemorrhagic cystitis. The HeartMate III LVAD inserted in this patient had not previously been tested or certified for use under hyperbaric conditions. To our knowledge this is the first report of the HeartMate III LVAD being used to support a patient undergoing hyperbaric treatment. The overview detailed here of the safety and technical aspects of managing this patient for hyperbaric treatment was possible due to the collaboration of a multi-disciplinary team. We believe that our experience has demonstrated a pathway to safe hyperbaric treatment of patients dependent upon a HeartMate III LVAD.

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Publication Type: Case report

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Diving Hyperb Med. 2023 June 30;53(2):151−154. doi: 10.28920/dhm53.2.151-154. PMID: 37365134.

Successful delayed treatment of acute glans penis ischaemia after adult circumcision: a case report

Kenneth Lo1,2, Darren Katz3,4,5, Vincent Chan3,5, Ian Millar1

1 Department of Intensive Care and Hyperbaric Medicine, Alfred Health, Melbourne, Australia
2 Department of Emergency Medicine, Alfred Health, Melbourne, Australia
3 Men’s Health Melbourne, Victoria, Australia
4 Department of Surgery, Western Precinct, University of Melbourne, Victoria, Australia
5 Department of Urology, Western Health, Victoria, Australia

Corresponding author: Dr Kenneth Lo, Hyperbaric Unit, Main Ward Block, Level 1, 55 Commercial Rd, Melbourne VIC 3004, Australia
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Keywords
Anticoagulation; Case report; Hyperbaric oxygen; Surgery; Tadalafil

Abstract

(Lo K, Katz D, Chan V, Millar I. Successful delayed treatment of acute glans penis ischaemia after adult circumcision: a case report. Diving and Hyperbaric Medicine. 2023 June 30;53(2):151−154. doi: 10.28920/dhm53.2.151-154. PMID: 37365134.)
Penile glans ischaemia post-circumcision is very rare. A 20-year-old male presented with glans ischaemia following an elective circumcision and was successfully treated with a combination of subcutaneous injection of low molecular weight heparin 0.5 mg·kg-1 twice-daily, oral Tadalafil 5 mg once-daily for three days and 12 hyperbaric oxygen treatments at 243 kPa (2.4 atmospheres absolute) beginning 48 hours after the onset of ischaemia.

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Publication Type: Case report

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Diving Hyperb Med. 2023 June 30;53(2):155−157. doi: 10.28920/dhm53.2.155-157. PMID: 37365135.

Hemiplegia resulting from acute carbon monoxide poisoning

Burak Turgut1, Kübra Canarslan Demir1, Gözde Büşra Sarıyerli Dursun1, Taylan Zaman1

1 Department of Underwater and Hyperbaric Medicine, University of Health Sciences, Gulhane Training and Research Hospital, Ankara, Turkey

Corresponding author: Dr Burak Turgut, SBÜ-Gülhane Eğitim ve Araştırma Hastanesi, Sualtı Hekimliği ve Hiperbarik Tıp Kliniği, Etlik/Ankara, Turkey
ORCiD: 0000-0002-9638-6221
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Keywords
Case reports; Hyperbaric oxygen treatment; Neurological manifestations; Recovery of function

Abstract

(Turgut B, Canarslan Demir K, Sarıyerli Dursun GB, Zaman T. Hemiplegia resulting from acute carbon monoxide poisoning. Diving and Hyperbaric Medicine. 2023 June 30;53(2):155−157. doi: 10.28920/dhm53.2.155-157. PMID: 37365135.)
Carbon monoxide (CO) poisoning can cause neurological complications such as movement disorders and cognitive impairment through hypoxic brain damage. Although peripheral neuropathy of the lower extremities is a known complication of CO poisoning, hemiplegia is very rare. In our case, a patient who developed left hemiplegia due to acute CO poisoning received early hyperbaric oxygen treatment (HBOT). The patient had left hemiplegia and anisocoria at the beginning of HBOT. Her Glasgow coma score was 8. A total of five sessions of HBOT at 243.2 kPa for 120 minutes were provided. At the end of the 5th session, the patient’s hemiplegia and anisocoria were completely resolved. Her Glasgow coma score was 15. After nine months of follow-up, she continues to live independently with no sequelae, including delayed neurological sequelae. Clinicians should be aware that CO poisoning can (rarely) present with hemiplegia.

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Publication Type: Case report

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