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Diagnosis of arterial gas embolism in SCUBA diving: modification suggestion of autopsy techniques and experience in eight cases

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Abstract

The purpose of this study was to suggest modifications of autopsy techniques in order to improve post-mortem diagnosis of arterial gas embolism (AGE) based on multidisciplinary investigation of SCUBA diving fatalities. Five adult human cadavers from the voluntary donation program of the Human Anatomy Laboratory, and eight judicial autopsied bodies of SCUBA divers from the Forensic Pathology Service were assessed. Before performing any autopsies, we accessed the diving plan and the divers’ profiles for each case. We then introduced a new dissection procedure that included identification, isolation, and manipulation of carotid, vertebral and thoracic arterial systems. The dissected vascular structures that allowed optimall isolation of the systemic arterial circulation were identified and ligated. In three of the eight judicial cases, we had a strongly suggestive history of arterial gas embolism following pulmonary barotrauma (PBt/AGE). In these cases, the additional arterial dissection allowed us to clearly diagnose AGE in one of them. The autopsy of the rest of the cases showed other causes of death such as asphyxia by drowning and heart attack. In all cases we were able to reject decompression sickness, and in some of them we showed the presence of artefacts secondary to decomposition and resuscitation maneuvers. These results allow us to suggest a specific autopsy technique divided into four steps, aimed at confirming or excluding some evidence of dysbaric disorders according to a re-enactment of the incident. We have demonstrated the presence of large volumes of intravascular air, which is typical of PBt/AGE.

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Acknowledgements

We gratefully acknowledge the contribution of our colleagues and technical staff of the Institute of Legal Medicine and Forensic Sciences (A. Hospital, MD; FJ. San Miguel, MD; JM. Martínez-Calcerrada, and L. Cifuentes) for their help during autopsies, and the Anatomy Laboratory of Faculty of Medicine (J. San, MD, PhD and A. Puig, MD) for their help in the anatomic dissections. Gerard Carot-Sans, PhD, edited the final version of the manuscript.

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Authors and Affiliations

  1. Institute of Legal Medicine and Forensic Sciences of Catalonia, (Division of Girona, Spain), Av. Ramón Folch, 4-6, 17001, Girona, Spain

    Josep M. Casadesús

  2. Research Group on Clinical Anatomy, Embryology and Neuroscience (NEOMA), Department of Medical Sciences, University of Girona, Girona, Spain

    Josep M. Casadesús, Ana Carrera, Pere Boadas-Vaello & Francisco Reina

  3. Department of Medical Sciences, Faculty of Medicine, University of Girona (Spain), Av. Emili Grahit 77, 17003, Girona, Spain

    Josep M. Casadesús, Ana Carrera, Pere Boadas-Vaello, Maria T. Serrando & Francisco Reina

  4. Special Group for Underwater Activities (GEAS) of the Spanish Civil Guard, C/Torroella s/n, 17258, Estartit, Spain

    Fernando Aguirre

  5. ICS-IAS Girona Clinical Laboratory, Av. Dr. Castany s/n, 17190, Salt, Spain

    Maria T. Serrando

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  1. Josep M. Casadesús
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  2. Fernando Aguirre
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  3. Ana Carrera
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Correspondence to Josep M. Casadesús.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional Research Committee and with the 1964 Helsinki Declaration and its later amendments, or comparable ethical standards.

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Casadesús, J.M., Aguirre, F., Carrera, A. et al. Diagnosis of arterial gas embolism in SCUBA diving: modification suggestion of autopsy techniques and experience in eight cases. Forensic Sci Med Pathol 14, 18–25 (2018). https://doi.org/10.1007/s12024-018-9951-4

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  • DOI: https://doi.org/10.1007/s12024-018-9951-4

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