Cardiac air transit following venous air embolism and right ventricular air aspiration*

Abstract

SummaryUsing intra-cardiac echocardiography in anaesthetised swine we tested the hypotheses that embolised air (i) passes immediately through the right atrium into the ventricle; (ii) persists in the right ventricle for a long time; (iii) is detectable for longer within the right ventricle or main pulmonary artery than the right atrium, and (iv) right ventricular aspiration recovers more air than right atrial aspiration. Following intravenous injection of different air volumes the air appeared in the right atrium in a mean (95% CI) of 3 s (2.5-3.5 s) and almost simultaneously in the right ventricle after 5 s (3.9-6.0 s), but air persisted for longer in the right ventricle (420 s; (367-473 s)) and pulmonary artery (541 s; (475-606 s)) than in the right atrium (404 s (353-457 s)), particularly with larger air volumes and in the semi-upright position. More air was recovered via a right ventricular catheter than an atrial catheter (52% vs 25%, p < 0.01).

Complications of CO2insufflation during endoscopic vein harvesting

“…These effects persisted up to 4 h after the event. Schäfer and colleagues conducted a study to characterize the transit of air through the heart by deliberately injecting a bolus of air into the venous circulation of pigs …”

“…Medical management involves optimizing ventricular preload, providing systemic heparizination, and pharmacologic elevation of blood pressure . Needle‐aspiration of the RV may be attempted under controlled circumstances . If these maneuvers are unsuccessful, emergent initiation of cardiopulmonary bypass is warranted …”

“…Schäfer and colleagues conducted a study to characterize the transit of air through the heart by deliberately injecting a bolus of air into the venous circulation of pigs. 31 Results indicate that air persists in the right ventricle (RV) for approximately 12 min after injection, while transiting quickly through the right atrium.…”