Denise F Blake1,2,3, Melissa Crowe4, Simon J Mitchell5, Peter Aitken6,7, Neal W Pollock8,9. 1. Emergency Department, The Townsville Hospital, Townsville, Queensland, Australia. 2. Marine Biology and Aquaculture, James Cook University, Townsville. 3. Corresponding author: IMB 23, Emergency Department, 100 Angus Smith Drive, The Townsville Hospital, Douglas, Queensland, Australia, 4814, denise.blake@health.qld.gov.au. 4. Discipline of Sport and Exercise Science, James Cook University, Townsville. 5. Department of Anaesthesiology, University of Auckland, Auckland, New Zealand. 6. College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville. 7. Health Disaster Management Unit, Queensland Health, Brisbane, Queensland. 8. Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, Canada. 9. Service de médecine hyperbare, Centre de médecine de plongée du Québec, Levis, Québec.
Abstract
INTRODUCTION: Vibration from a helicopter during aeromedical retrieval of divers may increase venous gas emboli (VGE) production, evolution or distribution, potentially worsening the patient's condition. AIM: To review the literature surrounding the helicopter transport of injured divers and establish if vibration contributes to increased VGE. METHOD: A systematic literature search of key databases was conducted to identify articles investigating vibration and bubbles during helicopter retrieval of divers. Level of evidence was graded using the Oxford Centre for Evidence-Based Medicine guidelines. A modified quality assessment tool for studies with diverse designs (QATSDD) was used to assess the overall quality of evidence. RESULTS: Seven studies were included in the review. An in vitro research paper provided some evidence of bubble formation with gas supersaturation and vibration. Only one prospective intervention study was identified which examined the effect of vibration on VGE formation. Bubble duration was used to quantify VGE load with no difference found between the vibration and non-vibration time periods. This study was published in 1980 and technological advances since that time suggest cautious interpretation of the results. The remaining studies were retrospective chart reviews of helicopter retrieval of divers. Mode of transport, altitude exposure, oxygen and intravenous fluids use were examined. CONCLUSION: There is some physical evidence that vibration leads to bubble formation although there is a paucity of research on the specific effects of helicopter vibration and VGE in divers. Technological advances have led to improved assessment of VGE in divers and will aid in further research. 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.
INTRODUCTION: Vibration from a helicopter during aeromedical retrieval of divers may increase venous gas emboli (VGE) production, evolution or distribution, potentially worsening the patient's condition. AIM: To review the literature surrounding the helicopter transport of injured divers and establish if vibration contributes to increased VGE. METHOD: A systematic literature search of key databases was conducted to identify articles investigating vibration and bubbles during helicopter retrieval of divers. Level of evidence was graded using the Oxford Centre for Evidence-Based Medicine guidelines. A modified quality assessment tool for studies with diverse designs (QATSDD) was used to assess the overall quality of evidence. RESULTS: Seven studies were included in the review. An in vitro research paper provided some evidence of bubble formation with gas supersaturation and vibration. Only one prospective intervention study was identified which examined the effect of vibration on VGE formation. Bubble duration was used to quantify VGE load with no difference found between the vibration and non-vibration time periods. This study was published in 1980 and technological advances since that time suggest cautious interpretation of the results. The remaining studies were retrospective chart reviews of helicopter retrieval of divers. Mode of transport, altitude exposure, oxygen and intravenous fluids use were examined. CONCLUSION: There is some physical evidence that vibration leads to bubble formation although there is a paucity of research on the specific effects of helicopter vibration and VGE in divers. Technological advances have led to improved assessment of VGE in divers and will aid in further research. 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.
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