‘Power under pressure’ – defibrillation during hyperbaric oxygen therapy: a scoping review

Introduction: Although defibrillation is the standard treatment for cardiac arrest with shockable rhythms, its safety during hyperbaric oxygen therapy (HBOT) remains uncertain, as the oxygen-enriched atmosphere and increased ambient pressure could, in case of sparking, increase fire and explosion risk. As established guidelines are lacking, this scoping review synthesizes the current knowledge, addressing the unique challenges that arise in this special environment. Methods: A systematic literature search was conducted in CINAHL, Cochrane Library, EMBASE and PubMed. Two authors independently screened titles and abstracts, with a third author resolving discrepancies. Duplicate records were removed after initial screening. Full-text screening was also performed independently by two authors. Manual data extraction focused on actual defibrillation during HBOT, including outcomes, safety concerns, recommendations and further helpful information. Results: The search initially identified 10,348 publications, ten of which were included. Screening of reference lists yielded another 23 publications, resulting in 33 finally included publications. Of these, four publications presented five patient cases of actual defibrillation during HBOT, while the remaining publications provided additional information on the topic. Conclusions: Findings highlight a lack of standardised guidelines and limited empirical data, necessitating cautious consideration of defibrillation during HBOT. Safety protocols, including oxygen level and equipment specifications, vary between monoplace and multiplace hyperbaric chambers, influencing the feasibility of in-chamber defibrillation. There is strong consensus that defibrillation is strictly contraindicated inside monoplace chambers, while in multiplace chambers, risks and benefits must be assessed individually. While defibrillation during HBOT is rare, ensuring its safety remains of paramount importance. Future research should focus on refining safety protocols and establishing guidelines to optimise patient outcomes during HBOT-associated emergencies.