The Rubicon Foundation: In-water Recompression

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RRR Suggested Reading List: In-water Recompression

Also check out the Wikipedia In-water recompression article, we recently added images and references.

Treatment of decompression sickness (DCS) utilizing the US Navy Treatment Table 6 with oxygen at 18m is a standard of care (1). Significant delay to treatment, difficult transport, and facilities with limited experience may lead one to consider on site treatment (2). Surface oxygen for first aid has been proven to improve the efficacy of recompression and decreased the number of recompression treatments required when administered within four hours post dive (3). In-water recompression (IWR) to 9 m breathing oxygen is one option that has shown success over the years (4, 5, 6). IWR is not without risk and should be undertaken with certain precautions (4, 7, 8, 9).

Six IWR treatment tables have been published in the scientific literature. Each of these methods have several commonalities including the use of a full face mask, a tender to supervise the diver during treatment, a weighted recompression line and a means of communication. The history of the three older methods for providing oxygen at 9m (30 fsw) was described in great detail by Drs. Pyle and Youngblood (4). The fourth method for providing oxygen at 7.5 m (25 fsw) was described by Pyle at the 48th Annual UHMS Workshop on In-water Recompression in 1999 (8). More recent is the development of the Clipperton and Clipperton-(a) methods for use on a scientific mission to the atoll of Clipperton, 1,300 km from the Mexican coasts. The Clipperton method involves recompression to 9m (30 fsw) while the Clipperton-(a) rebreather method involves a recompression to 30m (98 fsw) (10).

Brief History and Risks (9, 11)

The Royal Australian Navy School of Underwater Medicine was charged to supervise the then, non-sanctioned, practice of IWR. This charge was in response to the very long delays that were associated between the presentation of DCS and recompression treatment. Dr Edmonds also described the debates about underwater oxygen treatment for DCS that are not unlike current concerns.
* Inappropriate cases for treatment
* Oxygen Toxicity
* Emergency Termination of Treatment
* Hypothermia
* Adequacy of Equipment in Remote Areas
* Seasickness
* Operator Expertise and Training
* Safety of the Diving Attendant and the Boat Tenders
* Requirement for Medical Supervision
* Transport Availability
* Misuse of Equipment
* Pulmonary Barotrauma Cases

References:

1. Recompression treatments should be to a pressure equivalent to 18 m depth.
Moon RE. SPUMS 2000 Volume 30 Number 3.
RRR ID: 5865
(NOTE: Part 2 of 5 part Pro Con Debate at the 1999 SPUMS meeting.)

2. On-site recompression treatment is acceptable for DCI.
Brubakk, AO. SPUMS 2000 Volume 30 Number 3.
RRR ID: 5871
(NOTE: Part 5 of 5 part Pro Con Debate at the 1999 SPUMS meeting.)

3. First aid normobaric oxygen for the treatment of recreational diving injuries.
Longphre, Denoble, Moon, Vann, and Freiberger. Undersea Hyperb Med. 2007 Jan-Feb;34(1):43-9.
RRR ID: 5514

4. In-water Recompression as an emergency field treatment of decompression illness.
Pyle and Youngblood. SPUMS 1997 Volume 27 Number 3.
RRR ID: 6083
(NOTE: A version of this paper was originally published in aquaCorps 1995; Number 11, UNDERGROUND XPLORERS:35-46 without references.)

5. In-water Recompression (Letter to Editor).
Pyle, RL. SPUMS 1997 Volume 27 Number 3.
RRR ID: 6076

6. Diving and decompression sickness treatment practices among Hawaii's diving fishermen.
Farm, Hayashi, and Beckman. Sea Grant Technical Report UNIHI-TP-86-01. Honolulu: Sea Grant, 1986.
Sea Grant Library: UNIHI-TP-86-01

7. In-water oxygen recompression therapy for decompression sickness.
Knight, J. 1984. SPUMS J. 14(3):32-34.
RRR ID: not established, check back for updates

8. Kay E, Spencer MP (eds). In Water Recompression. 48th Undersea and Hyperbaric Medical Society Workshop. UHMS Publication Number RC103.C3. Kensington: Undersea and Hyperbaric Medical Society; 1999; 108 pages. RRR ID: 5629

9. Underwater oxygen treatment of decompression sickness.
Edmonds, C. SPUMS J. 1979; 9(1):17-26.
RRR ID: 6221

10. [Decompression sickness accident management in remote areas. Use of immediate in-water recompression therapy. Review and elaboration of a new protocol targeted for a mission at Clipperton atoll]
Blatteau JE, Jean F, Pontier JM, Blanche E, Bompar JM, Meaudre E, Etienne JL. Ann Fr Anesth Reanim. 2006 Aug;25(8):874-83. Epub 2006 Jul 21. Review. French.
PMID: 16860525, Thanks to Cristiana Jones for translating this for us.

11. Underwater oxygen treatment of decompression sickness: A review.
Edmonds, C. SPUMS J. 1995; 25(3):17-26.
RRR ID: 6428

Australian In-water Recompression Table

Hawaiian In-water Recompression Table

The Hawaiian IWR Table with Pyle modifications can be found in the proceedings of the DAN 2008 Technical Diving Conference (In Press) or through download from DAN here.

US Navy In-water Recompression Table

Pyle In-water Recompression Table

Clipperton In-water Recompression Tables

Additional References:

Treatment of decompression illness following mixed gas recreational dives.
Elliott, D. SPUMS 1997 Volume 27 Number 2.
RRR ID: 6060

In-water Recompression (Workshop Review).
Knight, J. SPUMS 2000 Volume 30 Number 1.
RRR ID: 5832

Mitchell SJ, Doolette DJ, Wachholz CJ, Vann RD (eds.). 2005. Management of Mild or Marginal Decompression Illness in Remote Locations Workshop Proceedings. Durham NC: Divers Alert Network. 240 pages. RRR ID: 5523

Diver rescue, decompression sickness and its treatment underwater using oxygen.
Knight, J. 1987. SPUMS J. 17(4):147-154.
RRR ID: not established, check back for updates

Trial of in-water oxygen recompression therapy in Antarctica.
Sullivan and Vrana. 1992. SPUMS J. 22(1):46-51.
RRR ID: not established, check back for updates

A treasured incident.
Author anonymous. SPUMS 1978 Volume 8 Number 1.
RRR ID: 6165
NOTE: Incident report, in-water recompression on air, depth 100 fsw.

Edmonds C. In-water oxygen recompression: A potential field treatment option for technical divers. aquaCorps 1993; 5:46-49. RRR ID: Not available

Hayashi, E.M. 1989. Emergency medical care: In the tropics. Diving for Science ... 1989. Proceedings of the American Academy of Underwater Sciences Ninth Annual Scientific Diving Symposium, American Academy of Underwater Sciences, Costa Mesa, CA, pp. 153-160. RRR ID: not established, check back for updates

THE EFFECT OF IN-WATER DECOMPRESSION PROFILE ON BUBBLE FORMATION FOLLOWING SURFACE DECOMPRESSION WITH OXYGEN.
Brubakk and Arntzen. UHMS 2001 Abstract. RRR ID: 1046

INDIGENOUS FISHERMAN DIVERS OF THAILAND: IN-WATER RECOMPRESSION.
Gold, Geater, Aiyarak, Juengprasert, and Chuchaisangrat. UHMS 1999 Abstract.
RRR ID: 774

IMMEDIATE IN WATER RECOMPRESSION - DOES IT MAKE A DIFFERENCE IN THE PATHOLOGY OF CENTRAL NERVOUS SYSTEM DECOMPRESSION SICKNESS?
Smith, Hardman, and Beckman. UHMS 1994 Abstract.
RRR ID: 5632

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