An unblinded training exposure to hypoxia enhances subsequent hypoxia awareness

Malfunctions and human errors in diving rebreathers can cause hypoxia, hyperoxia, and/or hypercapnia. We evaluated whether a prior unblinded hypoxia experience enhances a diver's ability to recognise hypoxia and initiate self-rescue.

Forty participants were randomised to receive either an information leaflet describing hypoxia symptoms or an unblinded hypoxia experience, prior to a blinded hypoxia testing exposure during a virtual reality dive over one month later. The primary outcome was the comparison of the proportion of participants in these two groups who initiated self-rescue before reaching a peripheral oxygen saturation of 70% in the blinded exposure. An individual's 'symptom profile' was assessed by comparing symptoms during the unblinded hypoxia experience and blinded testing exposures.

During the blinded hypoxia testing exposure, 18/20 (90%) participants in the hypoxia experience group performed a self-initiated rescue compared to 6/18 (33%) in the information leaflet group (P < 0.001). Participants in the information leaflet group had lower mean SpO₂ (73.4% vs 81.4%, mean difference 8% [95% CI = 2.5-13.5%, P = 0.005]) and lower inhaled oxygen fraction (7.6% vs 9.4%, mean difference 1.8% [95% CI = 0.6-3.1%, P = 0.005]) at self-rescue. The most frequent and severe symptoms were light-headedness and shortness of breath. Of the 20 participants completing both hypoxia exposures, 14 (70%) had a consistent hypoxia symptom profile, which was not related to the ability to recognise hypoxia.

Self-rescue was approximately three times more likely for participants who had previously experienced hypoxia compared to simply receiving information on relevant symptoms. Most participants exhibited a consistent pattern of individual symptoms, which did not result in earlier or improved detection of hypoxia.