Sudden deaths due to accidental intravenous injection of perfluorocarbon during MRI cranial examinations

Lanaro, Rafael; Capitani, Eduardo Mello De; Costa, José Luiz; Bucaretchi, Fábio; Togni, L. De; Linden, Rafael; Barbosa, Fernando; Tessaro, Elias Paulo; Bataglion, Giovana A.; Eberlin, Marcos N.; Zappa, José Eduardo Bueno; Almeida, Luis César; Kemp, Brigina; Miller, João Roberto

doi:10.1007/s11419-014-0231-z

Cited by 6 publications

(5 citation statements)

References 21 publications

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“…Toxicology reports showed the estimated volume of intravenous perfluorocarbon liquid was equal or over 180 mg/kg in all cases (the smallest fatal dose was estimated to be 6.8 mg/mL). The concluded mechanism of pulmonary venous gas embolism was secondary to the presence of nonabsorbable and high vapor pressure of FC-770 in the pulmonary capillaries [13]. In both of our cases, we used <7 mL perfluoro-n-octane (Perfluoron ® ) during the surgery and did not notice the egress of heavy liquid during the surgery.…”

Section: Discussion/conclusionmentioning

confidence: 87%

“…They suspected that heavy liquid outflow from the eye occurred through the cut end of a vortex vein in the sclera because of the raised intraoperative intraocular pressure. Lanaro et al [13] reported 3 unexpected deaths from pulmonary air embolism after accidental intravenous injection of perfluorocarbon liquid (FC-770). Toxicology reports showed the estimated volume of intravenous perfluorocarbon liquid was equal or over 180 mg/kg in all cases (the smallest fatal dose was estimated to be 6.8 mg/mL).…”

Section: Discussion/conclusionmentioning

confidence: 99%

“…There is an urgent need for multicenter studies, to enhance awareness, understanding, prevention, detection, and treatment of this complication of endoresection. Special precautions are indicated, which include: (a) informing patients of the risk of air embolism when obtaining consent for endoresection; (b) cauterizing any vortex veins in the quadrant of the tumor at the start of the operation; (c) monitoring for air emboli by intraoperative and postoperative ETCO 2, echocardiography or doppler scans; (d) internal jugular vein catheterization, to detect and aspirate any air emboli; (e) monitoring in the intensive care unit for at least 24 h postoperatively; and (f) multidisciplinary preparedness for prompt treatment of any pulmonary embolism, including facilities for immediate ECMO [13].…”

Section: Discussion/conclusionmentioning

confidence: 99%

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Fatal Air Embolism after Choroidal Melanoma Endoresection without Air Infusion: A Case Report

et al. 2021

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Background: The aim of this study was to report 2 cases of pulmonary air embolism developing several hours after choroidal melanoma endoresection without the use of air infusion during the surgery, with fatality in 1 patient. Methods: The method of this study was case report. Participants: Two patients with large choroidal melanomas who collapsed several hours after endoresection without air infusion as a result of pulmonary air embolism. Results: A 72-year-old man collapsed 4 h and 30 min after endoresection without air infusion. Computerized tomography angiography confirmed air embolism. The patient died after 86 min of cardiopulmonary resuscitation. A 41-year-old woman collapsed 5 h and 30 min after endoresection, performed without air infusion and with close monitoring, which included right internal jugular vein catheterization intraoperatively. Transthoracic and transesophageal echography, performed preoperatively, intraoperatively, and postoperatively, revealed air embolism only after collapse occurred. Imaging showed the embolism to be biventricular because of patent foramen ovale. The patient was treated promptly with extracorporeal membrane oxygenation and mechanical ventilation, which resulted in a full recovery. Conclusions: Air embolism can develop after endoresection for choroidal melanoma, despite avoiding air infusion. Further studies are needed to understand how this occurs. Special measures are indicated to detect this complication and to treat it promptly and effectively.

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Section: Discussion/conclusionmentioning

confidence: 87%

Section: Discussion/conclusionmentioning

confidence: 99%

Section: Discussion/conclusionmentioning

confidence: 99%

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Fatal Air Embolism after Choroidal Melanoma Endoresection without Air Infusion: A Case Report

et al. 2021

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“…In support of this mechanism, intravenous injection of 1 mL of FC 80 causes lethal gas embolism in dogs breathing room air, but not when breathing oxygenated FC 80 liquid fluorocarbon because, in the latter, total blood gas tension does not exceed the absolute alveolar gas tension [4]. Furthermore, intravenous injection of pure PFCLs have been associated with the development of lethal gas embolism in humans with the formation of gas bubbles in the pulmonary capillaries, even in small doses [5,6].…”

Section: Discussionmentioning

confidence: 99%

Perfluorocarbon syndrome—a possible, overlooked source of fatal gas embolism following uveal-melanoma endoresection

Rüschen

Romano

Ferrara

et al. 2022

Eye

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Endoresection of uveal melanoma involves vitrectomy, excision of tumour, retinal-laser under pefluorocarbon liquid (PFCL), PFCLsilicone oil (SO) exchange and cryotherapy to the sclerotomies. Intraoperative pressurised air is avoided as it can enter the bloodstream through vortex veins with potentially fatal pulmonary air embolism [1]. Perfluorodecalin (PFD) has been reported to enter the circulation during endoresection [2], with no systemic complications reported.We describe a case of fatal gas embolism a few hours after endoresection using intraoperative perfluoro-n-octane (PFO) and discuss whether egress of PFO could be causal.

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“…Most preparations of PFC are based on emulsion technology, because intravenous injection of high amounts of unprocessed PFC leads to death by spontaneous foaming in the lung (Lanaro et al 2014). This is mainly because PFCs are neither hydro- nor lipophile and, therefore, immiscible with aqueous fluids like blood.…”

Section: Main Textmentioning

confidence: 99%

Perfluorocarbons for the treatment of decompression illness: how to bridge the gap between theory and practice

Mayer

Ferenz

2019

Eur J Appl Physiol

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Decompression illness (DCI) is a complex clinical syndrome caused by supersaturation of respiratory gases in blood and tissues after abrupt reduction in ambient pressure. The resulting formation of gas bubbles combined with pulmonary barotrauma leads to venous and arterial gas embolism. Severity of DCI depends on the degree of direct tissue damage caused by growing bubbles or indirect cell injury by impaired oxygen transport, coagulopathy, endothelial dysfunction, and subsequent inflammatory processes. The standard therapy of DCI requires expensive and not ubiquitously accessible hyperbaric chambers, so there is an ongoing search for alternatives. In theory, perfluorocarbons (PFC) are ideal non-recompressive therapeutics, characterized by high solubility of gases. A dual mechanism allows capturing of excess nitrogen and delivery of additional oxygen. Since the 1980s, numerous animal studies have proven significant benefits concerning survival and reduction in DCI symptoms by intravenous application of emulsion-based PFC preparations. However, limited shelf-life, extended organ retention and severe side effects have prevented approval for human usage by regulatory authorities. These negative characteristics are mainly due to emulsifiers, which provide compatibility of PFC to the aqueous medium blood. The encapsulation of PFC with amphiphilic biopolymers, such as albumin, offers a new option to achieve the required biocompatibility avoiding toxic emulsifiers. Recent studies with PFC nanocapsules, which can also be used as artificial oxygen carriers, show promising results. This review summarizes the current state of research concerning DCI pathology and the therapeutic use of PFC including the new generation of non-emulsified formulations based on nanocapsules.

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Sudden deaths due to accidental intravenous injection of perfluorocarbon during MRI cranial examinations

Cited by 6 publications

References 21 publications

Fatal Air Embolism after Choroidal Melanoma Endoresection without Air Infusion: A Case Report

Fatal Air Embolism after Choroidal Melanoma Endoresection without Air Infusion: A Case Report

Perfluorocarbon syndrome—a possible, overlooked source of fatal gas embolism following uveal-melanoma endoresection

Perfluorocarbons for the treatment of decompression illness: how to bridge the gap between theory and practice

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