Cardiac arrest can occur during saturation or transfer under
pressure (TUP) bell runs. Taking into consideration that the recovery of
the bell to the surface, connection to the system, and transfer of the
casualty to the chamber would obviously take too long, the only solution
to recovering the casualty within an acceptable time is to perform
cardiopulmonary resuscitation (CPR) in the bell. The main problem with
diving bells is that they are spherical in shape and offer a limited
space occupied by piping, umbilicals, helmets, bailout systems, fins,
etc., especially near the bottom hatch, so that the space for CPR is very
limited, as we can see in the picture below.
To address this issue, companies have provided guidelines for
alternative cardiopulmonary resuscitation (CPR) techniques to the
traditional supine position. These include CPR with the casualty in a
sitting position at the bottom of the bell or in the moonpool with the
casualty still held by his harness. Other techniques that have been
commonly taught are head-to-chest and knee-to-chest compressions
(see the pictures below). However, these methods were not supported
by efficacy data, and recent tests discussed in a document titled
"Delivering Manual Cardiopulmonary Resuscitation (CPR) in a Diving Bell:
An Analysis of Head-to-Chest and Knee-to-Chest Compression
Techniques" by Dr. Graham Johnson, Dr. Philip Bryson, Dr. Nicholas
Tilbury, Dr. Benjamin McGregor, Dr. Alistair Wesson, Dr. Gareth D.
Hughes, Dr. Gareth R. Hughes, and Dr. Andrew Tabner conclude that
these two techniques are poorly effective and that the head-to-chest
technique has been found to cause harm to providers and should no
longer be taught, which confirms what many saturation divers think.
In another document titled "An Evaluation of the NUI Compact Chest
Compression Device (NCCD), a Mechanical CPR Device Suitable for Use
in the Saturation Diving Environment", which is, in fact, the continuation
of the above one, the same team of scientists has compared the
efficiency of the Compact Chest Compression Device (NCCD), a CPR
device developed by the Norwegian Underwater Institute (NUI), with
classical CPR techniques performed by experts. In addition to
providing guidelines for implementing this device, the authors conclude
that it is efficient. We can, therefore, suggest that such devices should
be systematically included in the bell's medical kit.
The NUI Compact Chest Compression Device (NCCD) is not the first
cardiac resuscitation device designed for hyperbaric conditions. For
example, we can refer to the excellent study entitled "Report on tests of
Zoll automatic external defibrillator function in hyperbaric heliox
conditions" by the Helix company, published on the Diving Medical
Advisory Committee (DMAC) website (https://www.dmac-
diving.org/guidance/). An automated external defibrillator (AED) is a
portable electronic device that can automatically diagnose and treat a
patient's potentially life-threatening cardiac arrhythmias of ventricular
fibrillation and ventricular tachycardia by defibrillating the heart.
However, despite the advantages of these devices, they have the
inconvenience of being powered by batteries, which, in addition to the
precautions to be implemented with lithium batteries stored in a
hyperbaric environment, may have an availability problem, resulting in
the preferred solution proposed that consists of having the device
outside the chamber with only the electrodes inside the chamber,
resulting in the device being operated by an operator outside the
chamber on the instructions of the diver medic. This solution would be
challenging to use with a diving bell for many technical reasons.
Unlike defibrillators, the Compact Chest Compression Device (NCCD) is
powered by compressed gas at a pressure of 10 bar above the
ambient pressure of the bell. Finding a gas supply source in the bell is
not a problem, so the availability problem is solved. The manufacturer
recommends not using mixtures with more than 22% PPO2 (NORSOK
standard limit is 22%) and continuously monitoring the PPO2 and
ambient pressure of the bell, which any trained supervisor is
accustomed to doing at all times. The machine consists of the following
parts, stored in a reinforced sealed box:
•
The compression unit, which includes the piston house, the bottom
plate, and the piston foot that transmit the movements of the piston
(see #1)
•
The hand control unit that allows starting and stopping the
compressions (see #2).
•
The supply hose connecting the hand control unit to the
compression unit (see #3).
•
The supply hose of the hand control unit equipped with a quick
connector (see #4).
•
A Velcro strap with adjustment markings (see #5) to secure the
compression unit in place.
•
An adjustable support strap designed to prevent the compression
unit from sliding down, ensuring the system provides adequate
compressions when the patient is in a vertical position. It is
equipped with carabiner hooks for attachment to the slots on the
compression unit's plate (see #6).
•
An extension hose of 1.5 m (see #7) and scissors that are strong
enough to cut fabrics (see #8) are also provided.
Note that in the study "An Evaluation of the NUI Compact Chest
Compression Device (NCCD), a Mechanical CPR Device Suitable for Use
in the Saturation Diving Environment", it is highlighted the the
compression unit may slide down when the casualty is in vertical
position, suggesting that the adjustable support strap (see #6) may
have to be better adapted.
The "User Manual" for this equipment is available in the "Medical
Equipment" subsection of the "Logistics" section on our website. It can
also be downloaded from the Norwegian Underwater Institute's (NUI)
website.
The Norwegian Underwater Institute (NUI) was established in 1973 to
continuously improve equipment safety, reduce health risks, and
enhance awareness in these areas. It is owned by the Association of
Operators for Hyperbaric Lifeboat Reception Facilities (OFHB), which
represents major oil operators and subsea contractors on the
Norwegian Continental Shelf. NUI is renowned for offering a range of
products and services, including research and development,
engineering, equipment testing, medical treatments and advisory
services, as well as courses and training. The organization can be
contacted through the links below.
•
Address: Gravdalsveien 245 - 5165 Laksevåg, Norway
•
Website: https://www.nui.no
•
Email: post@nui.no
•
Phone: +47 55 94 28 00
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About the Compact Chest Compression Device by NUI