High-Altitude Decompression Sickness Treated with Hyperbaric Therapy and Extracorporeal Oxygenation

Area of Science:

• Emergency Medicine
• Cardiovascular Medicine
• Neurology

Background:

• High-altitude decompression sickness (HADCS) is a rare but severe condition often linked to aviation incidents.
• This report presents the first documented case of severe HADCS treated with combined recompression therapy and veno-venous extracorporeal oxygenation (VV-ECMO).

Observation:

• A 51-year-old jet pilot experienced life-threatening HADCS following cabin depressurization, presenting with neurological deficits, dyspnea, edema, and cardiovascular collapse.
• The patient required intensive care, including hyperbaric oxygen therapy, mechanical ventilation, catecholamines, hemodialysis, and ultimately VV-ECMO due to oxygenation disturbances.

Findings:

• Initial recompression therapy showed neurological improvement, but subsequent cardiovascular collapse necessitated advanced life support.
• VV-ECMO was initiated on day two, and the patient's condition gradually improved, allowing for VV-ECMO discontinuation on day seven.
• The patient recovered fully with no neurological deficits and was discharged on day 19.

Implications:

• This case highlights the potential efficacy of combining recompression therapy with VV-ECMO for severe HADCS.
• Understanding the two distinct stages of HADCS, from hypoperfusion to multi-organ dysfunction, is crucial for timely and effective management.
• This approach may offer a life-saving option for patients with severe HADCS and associated complications.