Endorsed docs & guidelines – European Underwater and Baromedical Society

EUBS, as the encompassing Scientific Society for Diving and Hyperbaric Medicine in Europe, endorses the work and publications of the European Committee for Hyperbaric Medicine (ECHM). The Consensus Documents and Guidelines prepared by the ECHM can be downloaded from the ECHM website (www.echm.org). Other documents and Position Statements, as they will be prepared by the Publications Committee and approved by the ExCom, will be placed here in due time.

December 2023
ECHM-EUBS European Code of Good Practice – Review 2022

The main goal of this document is to present a European Code describing the minimum of requirements for operation of any medical centre serving hyperbaric therapies. This code has been compiled based on the existing experiences of experts from hyperbaric centres, committees, professional and scientific associations.
This code does not replace any national regulations, but it is intended to be a reference document for European countries to provide Guidelines, Regulations, and Standards in all fields of hyperbaric medicine.

This version of the Code is an update of the first edition of the document (published May 2004). The original 2004 edition was prepared by the Working Group “Safety” of the COST Action B14 “Hyperbaric Oxygen Therapy” by Jacek Kot, Secretary (Poland), Jordi Desola (Spain), Antonio Gata Simao (Portugal), Roly Gough- Allen (United Kingdom), Robert Houman (Belguim), Jean-Louis Meliet / Francois Galland (France), Christian Mortensen (Denmark), Peter Mueller (Denmark), Seppo Sippinen (Finland) and approved by the ECHM Board of Representatives.

The current review was approved by the ECHM Board of Representatives and endorsed by the EUBS. The following major modifications have been introduced in the current version:

The new job of the Safety Manager has been added to the list of hyperbaric facility staff.
Functions for hyperbaric facility staff have been described in the main text. The specific requirements for their background as well as for initial and continuous education has been left in external, referenced documents.
The system for classification of hyperbaric chambers, hyperbaric systems and hyperbaric facilities has been introduced.
The number of chambers, which can be operated simultaneously by one chamber operator, and the number of patients, which can attend inside the hyperbaric multiplace chamber, depending on the patients’ clinical status, have been added.
Description of clinical indications and contraindications have been added to the main text.
Three Annexes (1 – ECHM Educational and Training Standards for the Staff of Hyperbaric Medical Centres dated 1997; 2 – ECHM Recommendations for Safety in Multiplace Medical Hyperbaric Chambers dated 1998; 3 – on COST-B14 Working Group <Technical Aspects> Final Report dated 2001) have been removed from the main text (but referenced externally), with all their major conclusions being kept in the Code.
The Risk Assessment for installation of the monoplace chamber has been added as an Annex 5. This Annex has been prepared by Francois Burman within his extensive and long-lasting cooperation with ECHM.

The text can be downloaded (Open Access) from the DHM Website and distributed freely..

20 December 2022
ECHM-EUBS Joint Position Statement on the use of ‘mild hyperbaric therapies’ in humans

Within the European Union hyperbaric chambers are regarded as ‘class IIb medical device’ according to the Medical Devices Regulation (MDR) and have to meet strict safety standards to prevent harm to patients, caregivers, and third parties.

ECHM and EUBS make a Joint Position Statement on the use of pressure chambers marketed as ‘low-pressure hyperbaric chambers’ and claimed to be beneficial for a wide range of effects and wellness purposes.

You can download the document from the ECHM website and also here. More languages will be added:

COVID-19 Pandemic – Position Statements

In response to the current and ongoing COVID-19 (SARS-CoV-2) pandemic, the EUBS, but also other scientific societies in hyperbaric and diving medicine, have issued guidelines and recommendations for hyperbaric centres and the diving community. These documents highlight specific issues related to the diving and hyperbaric environment, besides the general recommendations issued by local, national and international health care authorities.

While the urgency of the COVID-19 pandemic seems to be (for now) less than in 2020-2021, these documents are kept as a reference and are accessible here.

European position paper on the management of patients with Patent Foramen Ovale.
Part 1. General approach and left circulation thromboembolism. European Heart Journal (2019) 40, 3182–3195
Part 2. Decompression sickness, migraine, arterial deoxygenation syndromes
and select high-risk clinical conditions. European Heart Journal (2021) 42, 1545–1553

The presence of a Patent Foramen Ovale (PFO) is implicated in the pathogenesis of a number of medical conditions; however, the subject remains controversial and no official statements have been published. This interdisciplinary paper, prepared with involvement of eight European scientific societies, aims to review the available trial evidence and to define the principles needed to guide decision making in patients with PFO. In order to guarantee a strict process, position statements were developed with the use of a modified grading of recommendations assessment, development, and evaluation (GRADE) methodology. A critical qualitative and quantitative evaluation of diagnostic and therapeutic procedures was performed, including assessment of the risk/benefit ratio. The level of evidence and the strength of the position statements of particular management options were weighed and graded according to predefined scales. Despite being based often on limited and non-randomized data, while waiting for more conclusive evidence, it was possible to conclude on a number of position statements
regarding a rational general approach to PFO management and to specific considerations regarding left circulation thromboembolism.

For some therapeutic aspects, it was possible to express stricter position statements based on randomized trials. This position paper provides the first largely shared, interdisciplinary approach for a rational PFO management based on the best available evidence.

Download these documents here:
Eur Heart J 2019 – Pristipino – Management of patients with PFO Part I
Eur Heart J 2021 – Pristipino – Management of patients with PFO Part II

Tenth European Consensus Conference on Hyperbaric Medicine: recommendations for accepted and non-accepted clinical indications and practice of hyperbaric oxygen treatment. Diving and Hyperbaric Medicine 2017; 47(1):24-32

The tenth European Consensus Conference on Hyperbaric Medicine took place in April 2016, attended by a large delegation of experts from Europe and elsewhere. The focus of the meeting was the revision of the European Committee on Hyperbaric Medicine (ECHM) list of accepted indications for hyperbaric oxygen treatment (HBOT), based on a thorough review of the best available research and evidence-based medicine (EBM). For this scope, the modified GRADE system for evidence analysis, together with the DELPHI system for consensus evaluation, were adopted. The indications for HBOT, including those promulgated by the ECHM previously, were analysed by selected experts, based on an extensive review of the literature and of the available EBM studies. The indications were divided as follows: Type 1, where HBOT is strongly indicated as a primary treatment method, as it is supported by sufficiently strong evidence; Type 2, where HBOT is suggested as it is supported by acceptable levels of evidence; Type 3, where HBOT can be considered as a possible/optional measure, but it is not yet supported by sufficiently strong evidence. For each type, three levels of evidence were considered: A, when the number of randomised controlled trials (RCTs) is considered sufficient; B, when there are some RCTs in favour of the indication and there is ample expert consensus; C, when the conditions do not allow for proper RCTs but there is ample and international expert consensus. For the first time, the conference also issued ‘negative’ recommendations for those conditions where there is Type 1 evidence that HBOT is not indicated. The conference also gave consensus-agreed recommendations for the standard of practice of HBOT.

Download the document here.

European Wound Healing Association (EWMA) 2017
Use of Oxygen Therapies in Wound Healing

The overall aim of this document is to highlight the present knowledge with regard to the use of oxygen therapies in the care and treatment of wounds of different aetiologies, which fail to progress through an orderly and timely sequence of repair. In this document, these types of wounds are defined as ‘non-healing’. Excluded from this document are animal and cellular models, acute wounds, such as surgical/trauma wounds and burns. The distribution of supplementary systemic oxygen at barometric pressure in connection with surgery is not covered by this document. We provide an overview of the treatment options, as well as assessments of the best available evidence on their respective results. In addition the document will go into detail with specific aspects and current discussions regarding the use of oxygen in wound healing including:

The role of oxygen and hypoxia in the wound healing process
Patient perspectives of oxygen treatment
Cost-effectiveness aspects of oxygen therapies
What remains controversial with suggestions for future actions.

In line with other similar documents published by the European Wound Management Association (EWMA) during recent years the document structure is inspired by the different elements that are usually included in the health technology assessment (HTA) approach. Thus, it is not a traditional position document that discusses different treatment strategies, when to use which product, or assesses one product against another, but rather a holistic picture of the current practice and reality of the use of oxygen therapies in wound healing.

Download this document here.

December 2023 ECHM-EUBS European Code of Good Practice – Review 2022

December 2023
ECHM-EUBS European Code of Good Practice – Review 2022