Air Embolism After Diving and Decisions Surrounding Air Transport

A healthy young woman sustained severe hyperbaric injury after scuba diving, despite having done previous dives. She had an asystolic cardiac arrest immediately after ascent and was resuscitated for 90 minutes before return of spontaneous circulation (ROSC). After ROSC, she remained profoundly unstable, on multiple vasopressors, with refractory hypothermia and hypoxemia. She was diagnosed with arterial gas emboli (AGE) leading to arrest. The only treatment for AGE is rapid hyperbaric oxygen therapy, but she was too acute to be cared for in any local hyperbaric chamber. The closest chamber that could accommodate a patient of her acuity was 440 miles away. The critical care transport team was prepared to transport her, but such a transport created numerous clinical and logistical challenges.