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Diving and Hyperbaric Medicine Diving and Hyperbaric Medicine The Journal of the South Pacific Underwater Medicine Society (Incorporated in Victoria) A0020660B and the European Underwater and Baromedical Society Volume 42 No. 3 September 2012 HBOT does not improve paediatric autism Diver Emergency Service calls: 17-year Australian experience Methods of monitoring CO2 in ventilated patients compared Australasian Workshop on deep treatment tables for DCI ‘Bubble-free’ diving – do bent divers listen to advice? Diving-related fatalities in Australian waters in 2007 ISSN 1833 3516 Print Post Approved ABN 29 299 823 713 PP 331758/0015 Diving and Hyperbaric Medicine Volume 42 No. 3 September 2012 PURPOSES OF THE SOCIETIES To promote and facilitate the study of all aspects of underwater and hyperbaric medicine To provide information on underwater and hyperbaric medicine To publish a journal and to convene members of each Society annually at a scientific conference SOUTH PACIFIC UNDERWATER EUROPEAN UNDERWATER AND MEDICINE SOCIETY BAROMEDICAL SOCIETY OFFICE HOLDERS OFFICE HOLDERS President President Mike Bennett <[email protected]> Peter Germonpré <[email protected]> Past President Vice President Chris Acott <[email protected]> Costantino Balestra <[email protected]> Secretary Immediate Past President Karen Richardson <[email protected]> Alf Brubakk <[email protected]> Treasurer Past President Shirley Bowen <[email protected]> Noemi Bitterman <[email protected]> Education Officer Honorary Secretary David Smart <[email protected]> Joerg Schmutz <[email protected]> Public Officer Member at Large 2011 Andrew Fock <[email protected]> Fiona Sharp <[email protected]> Chairman ANZHMG Member at Large 2010 David Smart <[email protected]> Jean-Michel Pontier <[email protected]> Committee Members Member at Large 2009 Peter Smith <[email protected]> Andreas Møllerløkken <[email protected]> Denise Blake <[email protected]> Liaison Officer Simon Mitchell (coopted) <[email protected]> Phil Bryson <[email protected]> Webmaster Glen Hawkins <[email protected]> ADMINISTRATION ADMINISTRATION Membership Honorary Treasurer & Membership Secretary Steve Goble <[email protected]> Patricia Wooding <[email protected]> 16 Burselm Avenue, Hainault, Ilford MEMBERSHIP Essex, IG6 3EH, United Kingdom For further information on SPUMS and to complete a membership Phone & Fax: +44-(0)20-85001778 application, go to the Society’s website: <www.spums.org.au> The official address for SPUMS is: MEMBERSHIP c/o Australian and New Zealand College of Anaesthetists, For further information on EUBS and to complete a membership 630 St Kilda Road, Melbourne, Victoria 3004, Australia application, go to the Society’s website: <www.eubs.org> DIVING and HYPERBARIC MEDICINE <www.dhmjournal.com> Editor-in-Chief: Editorial Board: Michael Davis <[email protected]> Costantino Balestra, Belgium c/- Hyperbaric Medicine Unit Michael Bennett, Australia Christchurch Hospital, Private Bag 4710 Alf Brubakk, Norway Christchurch, New Zealand Peter Germonpré, Belgium Phone: +64(0)33640045 or (0)3-329-6857 Jane Heyworth, Australia Fax: +64(0)3364-0817 or (0)3-329-6810 Jacek Kot, Poland European Editor: Simon Mitchell, New Zealand Peter Müller <[email protected]> Neal Pollock, USA Martin Sayer, United Kingdom Editorial Assistant David Smart, Australia Nicky McNeish <[email protected]> Journal distribution: Steve Goble <[email protected]> Submissions to the Journal should be sent to: <[email protected]> Diving and Hyperbaric Medicine is published jointly by the South Pacific Underwater Medicine Society and the European Underwater and Baromedical Society Diving and Hyperbaric Medicine Volume 42 No. 3 September 2012 125 these are important data contributing to the evidence base The Editor’s offering for hyperbaric medicine, and highlight the dangers of unsubstantiated enthusiastic adoption of HBOT for what the A search of the web on treating autistic children with UHMS describes as “off-list” conditions, such as multiple hyperbaric oxygen therapy (HBOT) brings up thousands sclerosis and cerebral palsy as two other neurological of hits; medical articles,1 videos, blogs from hyperbaric examples. Such practice only brings hyperbaric medicine chambers and parents, television and other news media into disrepute within mainstream Western medicine and items, even a Scientifi c American news blog. Many of these masks our increasing understanding of the underlying sources enthusiastically advocate HBOT, even though autism pathophysiological mechanisms that explain why high- does not appear in any of the SPUMS/ANZHMG, EUBS or pressure oxygen has a therapeutic role in some clinical UHMS lists of accepted indications for HBOT. conditions. A Canadian study, in which 24% oxygen at 1.3 ATA (131 Changing the subject, two aspects of the Australian diving kPa) was compared with air at slightly over normobaric fatality reports that have struck me are the number of divers pressure (1.03 ATA), reported improvement in various labelled as ‘obese’ and the frequency of lack of buoyancy neurobehavioural parameters in both groups, but signifi cantly control being a likely factor in the tragedy. Reviewing the more so in the ‘mild hyperbaric therapy’ group.2 However, past four years’ reports shows a quarter of scuba divers were this study does not test HBOT, as the oxygen component was obese and over another third overweight. What is probably only the equivalent of an FIO2 of about 0.32 at 101.3 kPa. more important than these labels is how they refl ect on lack Also, as Bennett has pointed out (unpublished observation, of physical fi tness, especially in the obese diver. I have 2011) the paper reports a difference in the change in outcome seen many novice divers being taught to dive overweighted measure compared to baseline, not the absolute value at the and to use their buoyancy compensator to achieve neutral end of the trial, and there is no difference between the groups buoyancy – a poor diving practice. Both of these aspects – when this is analysed. the importance of physical fi tness for safe scuba diving and buoyancy control training – need to be better addressed by The European Committee for Hyperbaric Medicine at its the dive training agencies in order to help reduce fatalities. 2010 workshop, in reviewing the use of HBOT for autism, and including this study, concluded “Currently there is no References clear rationale for HBOT in autism based on clinically proven pathophysiological mechanisms. The few studies on 1 Chungpaibulpatana J, Sumpatanarax T, Thadakul N, the use of pressurized environments (not always compatible Chantharatreerat C, Konkaew M, Aroonlimsawas M. with the defi nition of ‘hyperbaric oxygen therapy’) for autism Hyperbaric oxygen therapy in Thai autistic children. J Med have serious methodological limitations...HBOT should be Assoc Thai. 2008;91:1232-8. 2 Rossignol DA, Rossignol LW, Smith S, Schneider C, used only within the framework of an ethically approved Logerquist S, Usman A, et al. Hyperbaric treatment 3 clinical trial.” In a recent systematic review of HBOT for for children with autism: a multicenter, randomized, 4 treating autism, 18 publications were identifi ed. Two studies double-blind, controlled trial. BMC Pediatrics. 2009;9:21. were randomised, double-blind, controlled clinical trials. doi:10.1186/1471-2431-9-21 While some studies suggested that HBOT was effective, the 3 Kot J, Mathieu D. Controversial issues in hyperbaric oxygen conclusion of this review was that these promising effects therapy: a European College of Hyperbaric Medicine are not replicated. Therefore, sham-controlled studies with Workshop. Diving Hyperb Med. 2011;41:101-4. rigorous methodology are still needed in order to provide 4 Ghanizadeh A. Hyperbaric oxygen therapy for treatment of evidence-based data on HBOT therapy in autism. children with autism: a systematic review of randomized trials. Medical Gas Research. 2012;2:13. doi:10.1186/2045-9912- 2-13, published 11 May 2012. In this issue, Sampanthavivat and his colleagues in the 5 Sampanthavivat M, Singkhwa W, Chaiyakul T, Karoonyawanich Royal Thai Naval Medical Department report on just such S, Ajpru H. Hyperbaric oxygen in the treatment of childhood a carefully controlled RCT, with a sample size based on a autism: a randomised controlled trial. Diving Hyperb Med. pre-study power analysis of their unpublished pilot study.5 2012;42:128-33. In the present study, HBOT at 153 kPa (1.5 ATA) was compared with air at 116 kPa (1.15 ATA) in 58 children. Both Key words groups had signifi cant improvements in overall behaviour. Autism, hyperbaric oxygen therapy, research, editorials However, despite some inconsistent changes in some of the parameters studied which were diffi cult to interpret, overall, Michael Davis no signifi cant benefi t from HBOT could be shown. In both this and the Canadian study, only the short-term The front page photo was taken in the chamber at the outcome at the end of the study was measured, whereas Druckkammerzentrum, Unfallklinik Murnau, Germany longer-term follow up would be useful. It is to be hoped that and shows Nurse Nicole Maier keeping a young patient this may yet be possible in the Thailand study. Nevertheless, interested whilst undergoing HBOT. 126 Diving and Hyperbaric Medicine Volume 42 No. 3 September 2012 The Presidents’ pages Michael Bennett, President SPUMS particular on the formal separation of roles relating to the Society on the one hand and the Journal on the other. The In this, my fourth AGM report, I wish to begin by thanking Committee in general and Mike Davis in particular are the members present for continuing to support our Annual grateful to Jan Lehm for his efforts over the last year to Scientifi c Meeting with their attendance. I am certain they help make the positions of both entities increasingly clear. will agree with me that Cathy Meehan has done a tremendous While we will not have Jan’s services as Treasurer for much job organising this meeting – both from a social and scientifi c longer, we hope he will continue to offer his knowledge point of view.
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