Effectiveness of Risk Mitigation Interventions in Divers with PFO
Tuesday, May 21, 2019
Belmont Ballroom 2-3 (The Cosmopolitan of Las Vegas)
George Anderson
,
Divers Alert Network, Durham, NC
Douglas G. Ebersole, M.D.
,
none, Lakeland, FL
Derek Covington, M.D.
,
Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL
Petar J. Denoble, M.D., D.Sc.
,
Divers Alert Network, Durham, NC
Background:
Patent foramen ovale (PFO) is a recognized risk for decompression illness (DCI) in divers, which may be mitigated by conservative diving or by PFO closure. The aim of our study was to compare the effectiveness of these two risk mitigation interventions.
Methods:
This was a prospective study on divers who tested positive for PFO and either decided to continue diving without closure (“Conservative group”), or to close their PFO and continue diving (“Closure group”). Diver’s characteristics, medical history, history of diving and history of DCS were reported at enrollment and annually thereafter. The outcome measures were incidence of DCS, frequency and intensity of diving activities, and adverse events of closure.
Results
:
Divers in both groups dove less and had a lower incidence of confirmed DCS than prior to intervention. In the Closure group (n=42) the incidence of DCS decreased significantly. Divers with a large PFO experienced the greatest reduction in their burden of subjective DCS. In the Conservative group (n=20), the post-intervention decrease in DCS incidence was not significant. Of note, not all divers returned to diving after closure. 8 subjects reported mild adverse events associated with closure, 1 subject reported a serious adverse event.
Conclusions:
PFO closure should be considered on an individual basis. In particular, individuals who are young, healthy, have a significant DCS burden, a large PFO, and/or seek to pursue advanced diving may benefit from closure of PFO.
