Incidence, risk factors, and prognostic indicators of symptomatic air embolism after percutaneous transthoracic lung biopsy: a systematic review and pooled analysis

Abstract

Objectives To determine the incidence, risk factors, and prognostic indicators of symptomatic air embolism after percutaneous transthoracic lung biopsy (PTLB) by conducting a systematic review and pooled analysis. Methods We searched the EMBASE and OVID-MEDLINE databases to identify studies that dealt with air embolism after PTLB and had extractable outcomes. The incidence of air embolism was pooled using a random effects model, and the causes of heterogeneity were investigated. To analyze risk factors for symptomatic embolism and unfavorable outcomes, multivariate logistic regression analysis was performed. Results The pooled incidence of symptomatic air embolism after PTLB was 0.08% (95% confidence interval [CI], 0.048–0.128%; I2 = 45%). In the subgroup analysis and meta-regression, guidance modality and study size were found to explain the heterogeneity. Of the patients with symptomatic air embolism, 32.7% had unfavorable outcomes. The presence of an underlying disease (odds ratio [OR], 5.939; 95% CI, 1.029–34.279; p = 0.046), the use of a ≥ 19-gauge needle (OR, 10.046; 95% CI, 1.103–91.469; p = 0.041), and coronary or intracranial air embolism (OR, 19.871; 95% CI, 2.725–14.925; p = 0.003) were independent risk factors for symptomatic embolism. Unfavorable outcomes were independently associated with the use of aspiration biopsy rather than core biopsy (OR, 3.302; 95% CI, 1.149–9.492; p = 0.027) and location of the air embolism in the coronary arteries or intracranial spaces (OR = 5.173; 95% CI = 1.309–20.447; p = 0.019). Conclusion The pooled incidence of symptomatic air embolism after PTLB was 0.08%, and one-third of cases had sequelae or died. Identifying whether coronary or intracranial emboli exist is crucial in suspected cases of air embolism after PTLB. Key Points • The pooled incidence of symptomatic air embolism after percutaneous transthoracic lung biopsy was 0.08%, and one-third of patients with symptomatic air embolism had sequelae or died. • The risk factors for symptomatic air embolism were the presence of an underlying disease, the use of a ≥ 19-gauge needle, and coronary or intracranial air embolism. • Sequelae and death in patients with symptomatic air embolism were associated with the use of aspiration biopsy and coronary or intracranial locations of the air embolism.

Lung Biopsy as Rare Cause of Thromboembolic Stroke: A Case Report

“…Strokes as a complication are very rare and most are air emboli, with a risk of 0.06–0.08% [ 3 ]. Suspicion for cerebral air embolism is warranted when patients present with focal neurologic changes following lung biopsy procedures and supported by visualization of air intracranially on MRI or CT [ 4 , 5 ]. Additionally, if indeed a patient experienced an air embolism, a CT scan would detect even the smallest amounts of air due to air’s negative 1000 Hounsfield units, which creates a large contrast with brain parenchyma.…”

Computed Tomography-Guided Transthoracic Needle Biopsy: Predictors for Diagnostic Failure and Tissue Adequacy for Molecular Testing

“…Recently published data by Lee et al showed that pooled incidence of symptomatic air embolism after TTNB was 0.08% (95% CI, 0.048–0.128%), and one-third of cases had sequelae or died ( 23 ). The finding was in concordance with our result, where 0.12% (3/2,556) of our study cohort had symptomatic air emboli.…”

Systemic air embolism following computed-tomography-guided transthoracic needle biopsy of lung lesion – a systematic search of case reports and case series

“…The challenge is that systemic air embolisms after CT-TTNB are extremely rare, and the symptoms vary from completely asymptomatic to acute fatal with cardiac arrest as the first symptom. 4 , 5 Studies have systematically and for research purposes performed thoracic CT scans after CT-TTNB to identify systemic air embolisms and the literature report an incidence of approximately 0.08%–4.8%. 5 , 6 Risk factors for systemic air embolisms are described as cough during the procedure and high-pressure ventilation.…”

“… 4 , 5 Studies have systematically and for research purposes performed thoracic CT scans after CT-TTNB to identify systemic air embolisms and the literature report an incidence of approximately 0.08%–4.8%. 5 , 6 Risk factors for systemic air embolisms are described as cough during the procedure and high-pressure ventilation. The prospective and retrospective cohorts, gathered in systematic reviews and meta-analyses, aim to explore incidences and causal relationships (risk factors) of systemic air embolisms as described, but rarely focus on occurrence of rare events and how they are clinically handled.…”