Air Embolism: Diagnosis, Clinical Management and Outcomes

Abstract

Air embolism is a rare but potentially fatal complication of surgical procedures. Rapid recognition and intervention is critical for reducing morbidity and mortality. We retrospectively characterized our experience with air embolism during medical procedures at a tertiary medical center. Electronic medical records were searched for all cases of air embolism over a 25-year period; relevant medical and imaging records were reviewed. Sixty-seven air embolism cases were identified; the mean age was 59 years (range, 3–89 years). Ninety-four percent occurred in-hospital, of which 77.8% were during an operation/invasive procedure. Vascular access-related procedures (33%) were the most commonly associated with air embolism. Clinical signs and symptoms were related to the location the air embolus; 36 cases to the right heart/pulmonary artery, 21 to the cerebrum, and 10 were attributed to patent foramen ovale (PFO). Twenty-one percent of patients underwent hyperbaric oxygen therapy (HBOT), 7.5% aspiration of the air, and 63% had no sequelae. Mortality rate was 21%; 69% died within 48 hours. Thirteen patients had immediate cardiac arrest where mortality rate was 53.8%, compared to 13.5% (p = 0.0035) in those without. Air emboli were mainly iatrogenic, primarily associated with endovascular procedures. High clinical suspicion and early treatment are critical for survival.

Early hyperbaric oxygen therapy for cerebral air embolism during atrial fibrillation ablation

“…When air enters the circulation, it forms bubbles, thereby impairing the circulation. The clinical signs and symptoms related to the mechanism of air entrapment and the location of the air embolism . Neurological symptoms may occur as it is in our case.…”

“…HBO therapy plays a key role in the treatment of air embolism . It acts immediately on the air bubbles by increasing the ambient pressure and the oxygen tension in the blood .…”

“…Air embolism is a rarely seen during surgical and invasive procedures, but it is a potentially lethal complication. Air embolism may cause end‐organ ischemia or infarction if there is insufficient collateral supply . Air emboli to the coronary or cerebral circulation can have major adverse consequences, even when the volume of air is small .…”

“…Air embolism may cause end‐organ ischemia or infarction if there is insufficient collateral supply . Air emboli to the coronary or cerebral circulation can have major adverse consequences, even when the volume of air is small . Coronary artery air embolism during atrial fibrillation (AF) ablation has been reported previously .…”

“…1 Air emboli to the coronary or cerebral circulation can have major adverse consequences, even when the volume of air is small. 1 Coronary artery air embolism during atrial fibrillation (AF) ablation has been reported previously. 2,3 We present a case with cerebral air emboli during AF cryoballoon ablation.…”