Hyperbaric programs in the United States: Locations and capabilities of treating decompression sickness, arterial gas embolisms, and acute carbon monoxide poisoning: survey results.

Hyperbaric oxygen therapy is the primary treatment for arterial gas embolism, decompression sickness and acute carbon monoxide poisoning. Though there has been a proliferation of hyperbaric centers throughout the United States, a scarcity of centers equipped to treat emergency indications makes transport of patients necessary. To locate and characterize hyperbaric chambers capable of treating emergency cases, a survey of centers throughout the entire United States was conducted. Using Google, Yahoo, HyperbaricLink and the UHMS directory, a database for United States chambers was created. Four researchers called clinicians from the database to administer the survey. All centers were contacted for response until four calls went unreturned or a center declined to be included. The survey assessed chamber readiness to respond to high-acuity patients, including staff availability, use of medical equipment such as ventilators and intravenous infusion devices, and responding yes to treating hyperbaric emergencies within a 12-month period. Only 43 (11.9%, N = 361) centers had equipment, intravenous infusion pumps and ventilators, and staff necessary to treat high-acuity patients. Considering that a primary purpose of hyperbaric oxygen therapy is the treatment of arterial gas embolism and decompression sickness, more hyperbaric centers nationwide should be able to accommodate these emergency cases quickly and safely.

CO and CO2 analysis in the diving gas of the fishermen of the Yucatan Peninsula.

It is reported that more than 75% of 400 artisanal fisherman divers working off the Yucatan Peninsula experience decompression sickness (DCS) each year, making DCS an epidemic in this region. These divers use primitive hookah diving support systems (HDSS). Breathing air is supplied from inadequately filtered and poorly maintained gasoline-powered air compressors. We hypothesized that air supplies could be contaminated. Air contamination could produce symptoms consistent with some presentations of DCS. This could confound and falsely elevate the true incidence of DCS. A cross-sectional study was undertaken in a fishing community. Ten fishermen from a single cohort participated. Fishermen were instructed not to drain volume tanks following their last dive of the day before their diving air was sampled. Dräger carbon monoxide (CO) 5/a-P and carbon dioxide (CO2) 100/a Short-term Tubes were used to measure 1.0 liters (L) of gas through a Visi-Float flow meter at 0.2 L/minute. Average CO value was 42 ppm (8-150 ppm). Average CO2 was 663 ppm (600-800). Measurements exceeded recommended diving norms for CO of 20 ppm. CO2 exceeded one diving organization recommendation of 500 ppm. Separation of engine exhaust from compressor intake could decrease CO values in HDSS to acceptable standards thus eliminating one possible confounder from this DCS epidemic.

Treatment of carbon monoxide poisoning with hyperbaric oxygen and therapeutic hypothermia.

We present a preliminary case report series of severe, acute carbon monoxide poisoning in which both hyperbaric oxygen (HBO2) and therapeutic hypothermia (TH) were used to ameliorate neurological sequelae. Carbon monoxide poisoning is a standard indication for HBO2. While typically used postcardiac arrest, TH has been used for other types of hypoxic-ischemic brain injury. Four patients were found comatose from carbon monoxide exposure. They were intubated and treated with high-flow oxygen before transfer to our hospital for HBO2. All received three HBO2 treatments and 24 hours of TH with a goal temperature of 33 degrees C utilizing the CoolGard 3000 Intravascular Temperature Management System. While in the HBO2 chamber, cooling was maintained with ice bags in the groin, axillae and under the head. Three of the four cases were discharged home with normal neurological exams. One patient sustained severe, diffuse brain injury yet made a dramatic neurological recovery with only minor limitations in higher order memory and attention. No patient left the hospital with other end organ damage including cardiac dysfunction. To our knowledge, these are the first reported cases of the use of both HBO2 and TH to treat severe, acute carbon monoxide poisoning.