Vibration and bubbles: a systematic review of the effects of helicopter retrieval on injured divers

Blake, Denise F., Crowe, Melissa, Mitchell, Simon J., Aitken, Peter, and Pollock, Neal W. (2018) Vibration and bubbles: a systematic review of the effects of helicopter retrieval on injured divers. Diving and Hyperbaric Medicine, 48 (4). pp. 241-251.

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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.

Item ID: 56996
Item Type: Article (Research - C1)
ISSN: 1833-3516
Keywords: transport, scuba diving, decompression sickness, venous gas embolism (VGE), vibration, review article
Copyright Information: 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.
Funders: Townsville Hospital and Health Service (THHS)
Projects and Grants: THHS SERTA grant 2013_32
Date Deposited: 30 Jan 2019 07:33
FoR Codes: 32 BIOMEDICAL AND CLINICAL SCIENCES > 3202 Clinical sciences > 320219 Paramedicine @ 50%
51 PHYSICAL SCIENCES > 5105 Medical and biological physics > 510502 Medical physics @ 25%
40 ENGINEERING > 4001 Aerospace engineering > 400104 Avionics @ 25%
SEO Codes: 88 TRANSPORT > 8803 Aerospace Transport > 880302 Air Passenger Transport @ 50%
92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920199 Clinical Health (Organs, Diseases and Abnormal Conditions) not elsewhere classified @ 50%
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