DCS and AGE Journal Watch

May 2010

Decompression Sickness and Arterial Gas Embolism

Decompression Sickness (DCS) and Arterial Gas Embolism (AGE) are two of the potential hazards that confront individuals who dive occupationally or for pleasure. The Undersea and Hyperbaric Medical Society is committed to helping to prevent DCS and AGE and to ensuring that divers who suffer these conditions receive the best treatment possible. The new DCS and AGE section of the UHMS website is one way that this goal is accomplished.

The U.S. Navy Diving Manual Recompression Therapy Guidelines

The U.S. Navy is recognized as a world leader in the management of DCS and AGE. The section on recompression therapy from Revision 6 of the U.S. Navy Diving Manual contains the Navy’s latest recommendations for the treatment of DCS and AGE.

Recompression Therapy USN Diving Manual Rev 6

The Oriskany Dive Rescue Plan

Providing optimal treatment for a dive accident victim from the time that he or she surfaces from their dive until they reach a recompression chamber requires careful planning and coordination between dive boats, Coast Guard, EMS systems, and recompression facilities. Failure to have a well-developed plan in place for the management of dive accidents may result in unnecessary delays to recompression and a less favorable outcome for the stricken diver. One such plan was developed in Pensacola in 2007 to help with the management of diving accidents from the Oriskany dive site. Sunk in 212 feet of water and located 21 miles south of Pensacola, the Oriskany dive site is the largest artificial reef in the world and is extremely popular with divers from around the country. The dive accident management plan for this site and a Powerpoint presentation of the plan are now available for review. While this plan is specific to the Pensacola area, it may serve as a template for such plans in other locations.

Oriskany Rescue Plan 2009 UHMS NX
Oriskany Dive Accident Mgt Plan 10 January 2008

DCS and AGE Journal Watch

  Below is a list of recent publications that discuss the prevention and management of DCS and AGE.

MECHANISMS OF of DCS and AGE

Pontier J, Valée N, Bourdon L: Bubble-induced platelet aggregation in a rat model of decompression sickness. J Appl Physiol 2009;Oct:Epub ahead of print

Shäfer S, Neumann A, Lindemann J, et al: Venous air embolism induces both platelet dysfunction and thrombocytopenia. Acta Anaesthesiol Scand 2009;53:736-741

Pontier JM, Guerrero F, Castagna O: Bubble formation and endothelial function before and after 3 months of dive training. Aviat Space Environ Med 2009;80:15-19

Madden LA, Laden G: Gas Bubbles may not be the underlying cause of decompression illness- the at-depth endothelial dysfunction hypothesis. Med Hypotheses 2009;72:389-392

Eftedal OS, Lyderen S, Brubakk A: The relationship between venous gas bubbles and adverse effects of decompression after air dives. UHM 2007;34:99-15

EPIDEMIOLOGY OF DCS and AGE

Hawes, J, Massey EW: Neurologic injuries from scuba diving. Phys Med Rehabil Clin N Am 2009;20:263-272

Klingmann C, Gonnermann A, Dreyhaupt J, et al: Decompression illness reported in a survey of 429 recreational divers. Aviat Space Environ Med 2008;79:123-128

RISK FACTORS FOR DCS and AGE

Germonpre P, Pontier J, Gempp E, et al: Pre-dive vibration effect on bubble formation after a 30-m dive requiring a decompression stop. Aviat Space Environ Med 2009;80(12):1044-1048

Blatteau J, Pontier J: Effect of in-water recompression with oxygen to 6 msw versus normobaric oxygen breathing on bubble formation in divers. Eur J Appl Physiol 2009;Epub ahead of print

Lairez O, Cournot M, Minville V, et al: Risk of neurological decompression sickness in the diver with a right-to-left shunt: literature review and meta-analysis. Clin J Sports Med 2009;19:231-235

Mitchell SJ, Doolette DJ: Selective vulnerability of the inner ear to decompression sickness in divers with right-to left shunt: the role of tissue gas supersaturation. J Appl Physiol 2009;106:298-301

Mahon RT, Dainer HM, Gibellato MG, Soutiere SE: Short oxygen pre-breathe periods reduce or prevent severe decompression sickness in a 70 kg swine saturation model. J Appl Physiol 2009;106:1459-1463

Gempp E, Blatteau JE, Stephant E, Louge P: Relation between right-to-left shunt and spinal cord decompression sickness in divers. Brit J Sports Med 2009;30:150-3

Blatteau JE, Gempp E, Balestra C, Mets T, Germonpre P: Predive sauna and venous gas bubbles upon decompression from 400 kPa. Aviat Space Environ Med 2008;79:1100-1105

Newton HB, Burkhart J, Pearl D, Padilla W: Neurological decompression illness and hematocrit: analysis of a consecutive series of 200 recreational SCUBA divers. Undersea Hyberb Med 2008;35:99-106

Dujic Z, Valic Z, Brubakk AO: Beneficial role of exercise on SCUBA diving. Exerc Sport Sci Rev 2008;36:38-42

PREHOSPITAL MANAGEMENT

Zeindler P, Freiberger J: Triage and emergency evacuation of recreational divers a case series analysis. UHM 2010;37(2):133-139

Longphre JM, Denoble PJ, Moon RE, Vann RD, Freiberger JJ: First aid normobaric oxygen for the treatment of recreational diving injuries. Undersea Hyperb Med 2007;34:43-49

DIAGNOSIS AND EVALUATION

Wheen L, Williams M: Post-mortems in recreational scuba divers deaths: the utility of radiology. J Forensic Leg Med 2009;16:273-276

Erdem I, Yildiz S, Uzun G, et al: Cerebral white matter lesions in asymptomatic military divers. Aviat Space Environ Med 2009;80:2-4

Koch AE, Kirsch H, Reuter M, et al: Prevalence of patent foramen ovale and MRI-lesions in mild neurological decompression sickness. Undersea Hyperb Med 2008;35:197-205

Vann RD, Moon RE, Freiberger JJ, et al: Decompression illness diagnosis and decompression study design. Aviat Space Environ Med 2008;79:797-798

Grover I. Reed W, Neuman T: The SANDHOG criteria and its validation for the diagnosis of DCS arising from bounce diving. UHM 2007;34:199-210

RECOMPRESSION SCHEDULES

Bennett M, Lehm J, Mitchell S, et al: Recompression and adjunctive therapy for decompression illness: a systemic review of randomized controlled trails. Anesth Analg 2010;Epub ahead of print

Gempp E, Blatteau J: Risk factors and treatment outcome in scuba divers with spinal cord decompression sickness. J Crit Care 2009;Aug:Epub ahead of print

Antonelli C, Franchi F, Della Marta ME, et al: Guiding principles in choosing a therapeutic table for DCI hyperbaric therapy. Minerva Anestesiol 2009;75:151-161

Cianci P, Slade JB: Delayed treatment of decompression sickness with short, no-air-break tables: Review of 140 cases. Aviat Space Environ Med 2006;77:1003-1008

COMPLICATIONS OF RECOMPRESSION THERAPY

Demchenko IT, Ruehie A, Allen BW, Vann RD, Piantadosi CA: Phosphodiesterase-5 inhibitors oppose hyperoxic vasoconstriction and accelerate seizure development in rats exposed to hyperbaric oxygen. J Appl Physiol 2009;Jan - Epub ahead of print.

ADJUNCTIVE THERAPY

Bennett M, Lehm J, Mitchell S, et al: Recompression and adjunctive therapy for decompression illness: a systemic review of randomized controlled trails. Anesth Analg 2010;Epub ahead of print

Spiess B, Zhu J, Pierce B, et al: Effects of perfluorocarbon infusion in an anesthetized swine decompression model. J Surg Res 2009;153:83-94

Bessereau J, Coulange M, Genotelle N, et al: Aspirin in decompression sickness. Therapie 2008;63:419-423

ALTITUDE DCS

Jersey S, Baril R, McCarty R, et al: Severe neurological decompression sickness in a U-2 pilot. Aviat Space Environ Med 2010;81(1):64-68

DCS and AGE CASE REPORTS AND SERIES

Guillard E, Bénédicte N, Hervé F, et al: Intracerebral hemorrhage related to systemic gas embolism during hysteroscopy. UHM 2010;37(2):89-93

Ozyigit T, Egi S, Denoble P, et al: Decompression illness medically reported by hyperbaric treatment facilities: cluster analysis of 1929 Cases. Aviat Space Environ Med 2010;81(1):3-7

Linér M, Anderson J: Suspected arterial gas embolism after glossopharyngeal insufflations in a breath-hold diver. Aviat Space Environ Med 2009;81(1):74-76

Brockmeyer J, Simon T, Seery J, Johnson T, Armstrong P: Cerebral air embolism following removal of central venous catherter. Mil Med 2009;174:878

Vann R, Denoble P, Howle L, et al: Resolution and severity in decompression illness. Aviat Space Environ Med 2009;80:466-471

Lafère P, Germonpré P, Balestra C: Pulmonary barotrauma in divers during emergency free ascent training: review of 124 cases. Avait Space Environ Med 2009;80:371-375

Brandt M, Morrison T, Butler W; Decompression sickness rates for chamber personnel: case series from one facility. Avait Space Eviron Med 2009;80:570-573

Guy TS, Kelly MP, Carson B, Tseng E: Retrograde cerebral perfusion and delayed hyperbaric oxygen for massive air embolism during cardiac surgery. Interact Cardiovasc Thorac Surg 2009;8:382-383

Mooney RL: You're the flight surgeon – neurological decompression illness. Aviat Space Environ Med 2008;79:539-540

Trytko BE, Bennett MH: Arterial gas embolism: a review of cases at Prince of Wales Hospital, Sydney, 1996 to 2006. 
Anaesth Intensive Care 2008;36:60-64

Weisher DD: Resolution of neurological DCI after long treatment delays. Undersea Hyperb Med 2008;35:159-161

Bird N: CT finding of VGE in the portal veins and IVC in a diver with abdominal pain: a case report. Undersea Hyperb Med 2007;34:393-397

POST-TREATMENT MANAGEMENT

Bessereau J, Genotelle N, Chabbaut C, et al: Long-term outcome of iatrogenic gas embolism. Intensive Care Med 2010;Epub ahead of print

Harrah JD, O'Boyle PS, Piantadosi CA: Underutilization of echocardiography for patent foramen ovale in divers with serious decompression sickness. Undersea Hyperb Med 2008;35:207-211