Incidence of CGE in Britain

There is a large variation in reported CGE in different countries, which is difficult to explain

The graph below is compiled from existing publications, with the population of the drainage area as comparison:

 City/ Country
 Cases per 10 year period
 Population in million
 Paris 125 cases in 10 years (1) 12.2
 Marseille 86 cases in 20 years (~43 in 10 years) (4) 1.58
 Australia 39 cases in 10 years (5) 23
 Sydney 8 cases in 10 years (6) 4.4
 UK 5 cases in 10 years (BHA statistics)
A further 7 cases were not treated, see reasons below		 62.7

Population in green and number of cases treated in hyperbaric units in orange.

Reasons why 7 UK cases not accepted for treatment

 3 Patients too unstable

3 Too many comorbidities

 1 Patient brain dead


Non-HBO Statistics:

From the Website of the NPSA: National Reporting and Learning System (NRLS)

(Between June 2009 and June 2011 11 Cases reported

Following intentional removal of a central line.

Patients became breathless, confused, unconscious

or sustained a cardiac arrest.

See:

http://www.nrls.npsa.nhs.uk/resources/type/signals/?entryid45=13283



(These are numbers of ALL air/gas embolism, not only those involving the cerebral circulation)





UK statistics kindly provided by the ICNARC CMP indicate a possible 6-10 cases admitted to ICU/ year. No indication of the number with CGE and which are mainly systemic embolism. No indication of outcome is available either. This is significantly below the figures quoted from France, Australia and USA.
Patients that can be safely transferred for HBO, should be discussed with the nearest Hyperbaric unit. Time is of the essence.

With and without HBO, we need to know the outcome of every case of CVGE:

Why the huge difference in numbers treated between the UK and France/Australia ?

  1. Lack of belief in hyperbaric therapy?
  2. Under-estimating seriousness and the Pathophysiology of RCVGE?
  3. Misdiagnoses as stroke, TIA, Anaphylaxis, etc
  4. CGE classified as a “NEVER EVENT” with associated penalties makes acknowledgement unattractive- however line related gas embolism has been removed from the list of never events in the UK. This has not increased reporting.

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