Understanding scuba diving fatalities: carbon dioxide concentrations in intra-cardiac gas.

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Version: Final published version
Serval ID
serval:BIB_67543DF3D92C
Type
Article: article from journal or magazin.
Collection
Publications
Title
Understanding scuba diving fatalities: carbon dioxide concentrations in intra-cardiac gas.
Journal
Diving and hyperbaric medicine
Author(s)
Varlet V., Dominguez A., Augsburger M., Lossois M., Egger C., Palmiere C., Vilarino R., Grabherr S.
ISSN
1833-3516 (Print)
ISSN-L
1833-3516
Publication state
Published
Issued date
06/2017
Peer-reviewed
Oui
Volume
47
Number
2
Pages
75-81
Language
english
Notes
Publication types: Case Reports ; Journal Article
Publication Status: ppublish
Abstract
Important developments in the diagnosis of scuba diving fatalities have been made thanks to forensic imaging tool improvements. Multi-detector computed tomography (MDCT) permits reliable interpretation of the overall gaseous distribution in the cadaver. However, due to post-mortem delay, the radiological interpretation is often doubtful because the distinction between gas related to the dive and post-mortem decomposition artifactual gases becomes less obvious.
We present six cases of fatal scuba diving showing gas in the heart and other vasculature. Carbon dioxide (CO₂) in cardiac gas measured by gas chromatography coupled to thermal conductivity detection were employed to distinguish decomposition from embolism based on the detection of decomposition gases (hydrogen, hydrogen sulfide and methane) and to confirm arterial gas embolism (AGE) or post-mortem offgasing diagnoses. A Radiological Alteration Index (RAI) was calculated from the scan.
Based on the dive history, the intra-cadaveric gas was diagnosed as deriving from decomposition (one case, minimal RAI of 61), post-mortem decompression artifacts (two cases, intermediate RAI between 60 and 85) and barotrauma/AGE (three cases, maximal RAI between 85 and 100), illustrating a large distribution inside the bodies.
MDCT scans should be interpreted simultaneously with compositional analysis of intra-cadaveric gases. Intra-cadaveric gas sampling and analysis may become useful tools for understanding and diagnosing scuba diving fatalities. In cases with short post-mortem delays, the CO₂ concentration of the cardiac gas provides relevant information about the circumstances and cause of death when this parameter is interpreted in combination with the diving profile.

Keywords
Adult, Aged, Air, Artifacts, Autopsy, Barotrauma/complications, Barotrauma/diagnosis, Carbon Dioxide/analysis, Chromatography, Gas, Decompression/adverse effects, Decompression Sickness/diagnosis, Diving/adverse effects, Drowning/diagnosis, Drowning/etiology, Embolism, Air/complications, Embolism, Air/diagnosis, Femoral Artery, Femoral Vein, Gases/analysis, Heart/diagnostic imaging, Humans, Hydrogen/analysis, Jugular Veins, Male, Middle Aged, Multidetector Computed Tomography, Nitrogen, Oxygen/analysis, Postmortem Changes, Subclavian Vein, Thermal Conductivity, Air embolism, Arterial gas embolism, Decompression sickness, Diving deaths, Drowning, Gases
Pubmed
Web of science
Create date
27/06/2017 8:56
Last modification date
20/08/2019 14:22
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