Table 3.

Further recommendations on specific aspects of CPR during hyperbaric oxygen therapy (HBOT)

Recommendations on chest compression	♣ Immediate start of CPR [7, 14, 27, 35, 38, 45, 59, 61–63] ♣ If extraglottic device possible: 30:2, if no extraglottic device possible: compression only [42] ♣ Consider use of mechanical CPR device for evacuation [6]
Recommendations on defibrillation	♣ Precordial thump controversial [38], [37] ♣ Store defibrillator outside chamber for safety [2, 6, 7, 13, 27, 29, 35, 37, 38, 59, 61–63] ♣ Use adhesive plates [2] [28] [63] [14] ♣ 2 defibrillators certified for HBOT (Physiocontrol LifePak 1000; Corpuls3) [38]
Recommendations on airway/breathing	♣ Oropharyngeal airway [6, 27] [59, 63] with largest possible ET [61] ♣ Inflate cuffs with water or saline instead air [7] [27] [45] [61] [62] [14, 36] ♣ Video laryngoscope available inside of chamber [64] ♣ i-gel™ favorable [37, 42] ♣ Two certified HBOT ventilators (Italian Siaretron 1000 Iper [60 VF] and Maquet Servo-i HBO) [38]
Recommendations on medication	♣ i.v. lines placed before HBOT [27, 64] [59] ♣ Plastic containers have to be vented, glass bottles risk of gas embolism during decompression [38] ♣ One certified syringe pump (Pilot Hyperbaric, Fresenius Vial S.A.) [38]
Recommendations on chamber type	♣ CPR in chambers = confined spaces, potential risks increase [27, 32, 62, 65–67] ♣ Multiplace chambers with possible benefits in case of CPR during HBOT [2, 22, 45, 58, 62, 63]
Further considerations and information	♣ Interprofessional, close collaboration and training needed [2, 6, 14, 45, 64, 66] ♣ Proper examination prior to HBOT essential [6, 27, 28, 45, 68] (e.g., if Pneumothorax [7, 27, 56), drained?) as well as attention to reversible causes in case of cardiac arrest [6, 66]

CPR = cardiopulmonary resuscitation; HBOT = hyperbaric oxygen therapy; ET = endotracheal tube