Development of an algorithm to guide management of cardiorespiratory arrest in a diving bell

Abstract

Aim: The management of cardiorespiratory arrest in a diving bell presents multiple clinical, technical, and environmental considerations that standard resuscitation algorithms do not address, and no situation-specific algorithm exists. The development and testing of an algorithm to guide the management of cardiorespiratory arrest in a bell is described.

Methods: An iterative approach to algorithm development was used. Phase 1 involved a small multidisciplinary group and took place in a simulation centre and a decommissioned diving bell. The algorithm was then refined in a purpose-build simulation complex with repeated simulation by a group of divers, and with input from industry experts. ALS principles were followed unless contextual or technical factors necessitated deviation.

Results: Clinical and technical aspects of the resuscitation are addressed. Key priorities that conflict with standard ALS principles are: prioritisation of rescue breaths; use of mechanical CPR when available; and the provision of CPR with the casualty in a seated position where necessary.

Conclusion: This is the first algorithm to guide the delivery of resuscitation in a diving bell. It incorporates adapted ALS principles and available data concerning compression technique effectiveness, and was informed by industry and clinical expertise. It provides guiding principles that can be adapted to setting-specific needs, and we would encourage its industry-wide international adoption.

Keywords: Algorithm; Austere environment; Diving bell; Mechanical CPR; Pre-hospital; Resuscitation.

Fig. 1

a (left). Diving bell schematic. A diving bell in cross-section. b (right). Diving bell exterior. The diving bell on site at the Royal Derby Hospital, with a Resusci Anne QCPR suspended below, together with some equipment.

Fig. 2

Purpose-built simulation complex, Dunoon. Facilities included both bottom-mating (left) and side-mating (right) diving bells, simulated TUP (“wet pot”) and saturation chamber.

Fig. 3

Algorithm for the resuscitation of a diver in cardiorespiratory arrest in a diving bell.

Fig. 4

Casualty position when suspended from hoist.

Fig. 5

Casualty position once collar and iGel applied.

Fig. 6

Knee-to-chest CPR simulated on land (left) and in a diving bell (right).

Fig. 7

Upright (“Dunoon”) CPR, simulated on land (left) and in a diving bell (right).