A review of accelerated decompression from heliox saturation in commercial diving emergencies

Introduction: Saturation diving is a specialised method of intervention in offshore commercial diving. Emergencies may require the crew to be evacuated from the diving support vessel. Because saturation divers generally need several days to reach surface, the emergency evacuation of divers is based on dedicated hyperbaric rescue systems. There are still potential situations for which these systems cannot be used or deployed, and where an emergency decompression provides an alternative solution. Methods: Our objective was to describe historical cases and assess the benefit of emergency decompressions, with the collection of data from the authors’ direct experience and networks, providing witness or first-hand information. Results: We documented three cases of emergency decompression following bell evacuations, and six cases of accelerated decompression performed in the chamber or hyperbaric rescue chamber. Review of these cases showed: 1) the complicated nature of such emergencies that make decisions difficult; 2) the variety of solutions implemented; and 3) the surprisingly safe and successful outcomes of several operations. Analysis of the accelerated decompression occurrences allowed derivation of the options used; upward initial excursion, increased chamber partial pressure of oxygen associated to increased ascent rates, and inert gas switching. We identified four published procedures for accelerated decompression. Conclusions: Despite modern hyperbaric rescue systems, accelerated decompression remains an essential tool in case of emergency. The diving industry needs clear guidance on what can be achieved, depending on the saturation depth and the level of emergency.