DCI--speed of evacuation & treatment outcome.+

[DocVikingo]

Kev, The study authors don't advocate delaying treatment of a diver with minor DCS. The point was to look at delays in treatment vs. treatment outcomes. For minor DCS (defined as pain or tingling), the data the authors analyzed indicated that a delay in treatment up to 20 hours did not influence the treatment outcome. This supports their contention that medical personnel should analyze the risks and benefits of different evacuation methods when determining how an injured diver will be transported.DDM

Exactly the point.

Thanks,

Doc

 

[Kevrumbo]

Going thru my files and located this. . .

CONCLUSION: More data are needed assess the benefits of faster evacuations. However, in real-world scenarios with EvCTs in the 20-hour range, time did not influence outcome. Risk-benefit analysis of emergency transport is advised, especially for mild cases of DCI with a low probability of symptom progression.”

Regards,

DocVikingo

The caveat being -to a Certified First Responder (Dive Master, Dive buddy, Deck hand, Boat Captain etc) or as a potential victim of DCS- you don't know whether or not you have "a mild case of DCI with low probability of progression". IMO, an interesting academic study for physicians/professional EMS personnel after the fact --but with a trivial conclusion above that has no utility or application for an "actual real world scenario" post-dive. The dilemma of immediate evacuation vs transport risk still remains evident. . .

 

[DocVikingo]

The dilemma of immediate evacuation vs transport risk still remains evident. . .

Hi Kev,

Agreed. However, as the research develops it appears to strengthen the argument against risky haste in seeking recompression, e.g.:

Diving Hyperb Med. 2011 Sep;41(3):129-34.

Risk factors and clinical outcome in military divers with neurological decompression sickness: influence of time to recompression.

Blatteau JE, Gempp E, Constantin P, Louge P.

Source

Chef de l'Equipe Residante de Recherche Subaquatique Operationnelle (ERRSO), Institut de Recherche Biomedicale des Armees (IRBA), Toulon, France.

Abstract

BACKGROUND:

This study was designed to examine the influence of short delay to recompression and other risk factors associated with the development of severe neurological decompression sickness (DCS) in military divers.

METHODS:

Fifty-nine divers with DCS treated in less than 6 hours from onset of symptoms to hyperbaric recompression were included retrospectively. Diving parameters, symptom latency and recompression delay were analysed. Clinical symptoms were evaluated for both the acute event and one month later.

RESULTS:

Median delay to hyperbaric treatment was 35 min (2-350 min). Resolution was incomplete after one month in 25.4 % of divers with DCS. Multivariate analysis demonstrated that severe symptoms, classified as sensory and motor deficits or the presence of bladder dysfunction, were predictors of poor recovery with adjusted odds ratios (OR) of 4.1 (1.12 to 14.92) and 9.99 (1.5 to 66.34) respectively. There was a relationship between a longer delay to treatment and incomplete recovery, but the increased risk appeared negligible with an adjusted OR of 1.01 (1-1.02).

CONCLUSION:

Our results suggest that neurological severity upon occurrence is the main independent risk factor associated with a poor outcome in military divers with DCS. Clinical recovery was not dramatically improved in this series when recompression treatment was performed promptly.”

Regards,

DocVikingo

 

[DocVikingo]

I've received a number of questions relating to the significance these studies.

I think the important take-away from the research to date is that supervising dive professionals and medical personnel should weigh the risks and benefits of various evacuation and treatment methods when determining how an injured diver will be transported and medically handled. As the research develops, it appears to strengthen the argument against risky haste in seeking recompression, be that risky transport methods or risky treatment approaches (e.g., in water recompression (IWR)).

Regards,

DocVikingo

 

[pdenoble]

I agree with DocVikingo. Somebody mentioned my persentation at DEMA 2011 about IWR. My intention was to deliver this same message and I hope I succeded.