Review the availability of EHC for SCAE with respect to Joint Commission Certified CSC in the Mid-Atlantic Region

SCAE is a rare cause of stroke that may be difficult to recognize. Once it is identified, hyperbaric therapy (HT) in hyperbaric chambers (HC) may be indicated to improve outcome.

We started by reviewing SCAE cases at our CSC in Western North Carolina and identifying any barriers to HT. We compared North Carolina CSC to statewide HC, specifically those with 24/7 staffing or emergency HC (EHC). In the other mid-Atlantic areas of Maryland (MD), Virginia (VA), District of Columbia (DC) and South Carolina (SC), we compared EHC to CSC.  

We reviewed 6 cases of SCAE at our CSC. Only one underwent HT, in a local HC.  Availability, patient stability, distance and clinical improvement were identified as barriers to HT. In North Carolina we mapped 9 CSCs, 32 HCs and 1 EHC or a ratio of 1/9 for EHC to CSC.  MD, VA, DC and SC EHC to CSC ratios were 1/3, 1/3, 0/3, and 2/2 respectively.

SCAE qualifies as a complex stroke problem. Even though the current CSC certification process does not include this rare stroke subtype, a working knowledge of SCAE is valuable for the CSC. Guidelines for hyperbaric therapy in SCAE are lacking and state lines are artificial boundaries for patient care. HC are widespread, but most are for wound healing and not EHC. EHC are expensive and declining in number.  The Divers Alert Network is a reliable resource for finding EHC. For CSC, we recommend an education process for SCAE which contains plans for accessing EHC whether in state or out of state. Individual state EHC/CSC ratios are only one part of a best practice model for SCAE.