Implantable Cardioverter Defibrillator (ICD)

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As far as the Implantable Cardioverter Defibrillator (ICD) on the Use with Caution in a Monoplace Chamber Material List, the concern is the device withstanding pressure in the tank, per the list. Is there no/limited concern due to energy of any potential shock from the ICD in the tank?
My research finds there was a suspicion that if ICD leads are damaged, ignition could occur if the ICD discharges, so some experts advised that defibrillation mode of the ICDs should be deactivated before HBOT (Schmitz S, Churchill S, Weaver LK. Hyperbaric oxygen in patients with implanted cardiac defibrillators and pacemakers. Undersea & Hyperbaric Medicine. 2006;33(5):349). Assuming the ICD and leads are intact, practice is to confirm with the manufacturer each model of ICD prior to HBOT, that the device can withstand pressure and increased oxygen? Thank you!

Mar 22, 2023 by Sarah Karson, RN, BSN

4 replies

Eugene Worth
MD, M.Ed., FABA, ABPM/UHM

Great question and great research Sarah!!

Due to your extensive preparation, i don't need to go through the literature. I have talked directly to Dr. Weaver about his opinion stated in the paper. We are both on the UHMS Safety Committee. I thought sure that the committee had answered this question in the past, but I cannot find the MEDFAQ that addresses it.

Let's just say that well thought opinions are on both sides of this issue. That is, can the AICD generate such electromotive energy to spark outside the body? I think that there might be enough to cause an internal burn that might burn the skin, but no spark risk. Dr. Weaver feels differently.

The bigger questions are: 1) Why does this patient have an AICD in the first place? I want the unit interrogated to find out the last time it fired and for what reason. If this patient is unstable from a cardiology standpoint, I wouldn't put them in the hyperbaric chamber, and 2) Are the leads shorted in any way?

At one point, Dr. Weaver recommended turning the AICD part off during treatments. That seems untenable to me since a cardiologist, or PA, or NP would need to turn it off and come back in two hours to turn it back on again ... every day for 30+ treatments. If the unit hasn't fired, then why bother with this?

And, if you are worried about potential spark, I'd consider placing a damp/wet washcloth over the pacemaker pocket and continue with the treatments.

Finally, yes, with the make and serial number, call the manufacturer to see what pressure limits are for each model. Have them fax the hyperbaric assessment to you and include it in the patient chart.

Other colleagues here might differ with my opinion. Feel free to join the discussion.

Mar 22, 2023

Eugene Worth
MD, M.Ed., FABA, ABPM/UHM

Here are several articles about this problem. None of them are HBOT in nature, but you can glean some interesting information from the abstracts/papers.

Mar 23, 2023

Sarah Karson
RN, BSN

Thank you! I appreciate your time in providing a response and adding the articles.
Sarah

Mar 24, 2023

Eugene Worth
MD, M.Ed., FABA, ABPM/UHM

Good luck.

Mar 24, 2023

* Information provided without clinical evaluation and is not intended as a replacement for in-person consultation with a medical professional. The information provided through Curbside Consult is not a substitute for proper training, experience, and exercising of professional judgment. While every effort has been made to ensure the accuracy of the contents, neither the authors nor the Wound Reference, Inc. give any guarantee as to the accuracy of the information contained in them nor accept any liability, with respect to loss, damage, injury or expense arising from any such errors or omissions in the contents of the work.

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