-
Anaesthesia Jan 2017
Topics: Embolism, Air; Guidelines as Topic; Humans; Hyperbaric Oxygenation; Intracranial Embolism; Intraoperative Complications; Vascular Access Devices
PubMed: 27988963
DOI: 10.1111/anae.13759 -
Medicine Jun 2021Air embolism has the potential to be serious and fatal. In this paper, we report 3 cases of air embolism associated with endoscopic medical procedures in which the...
INTRODUCTION
Air embolism has the potential to be serious and fatal. In this paper, we report 3 cases of air embolism associated with endoscopic medical procedures in which the patients were treated with hyperbaric oxygen immediately after diagnosis by transesophageal echocardiography. In addition, we systematically review the risk factors for air embolism, clinical presentation, treatment, and the importance of early hyperbaric oxygen therapy efficacy after recognition of air embolism.
PATIENT CONCERNS
We present 3 patients with varying degrees of air embolism during endoscopic procedures, one of which was fatal, with large amounts of gas visible in the right and left heart chambers and pulmonary artery, 1 showing right heart enlargement with increased pulmonary artery pressure and tricuspid regurgitation, and 1 showing only a small amount of gas images in the heart chambers.
DIAGNOSES
Based on ETCO2 and transesophageal echocardiography (TEE), diagnoses of air embolism were made.
INTERVENTIONS
The patients received symptomatic supportive therapy including CPR, 100% O2 ventilation, cerebral protection, hyperbaric oxygen therapy and rehabilitation.
OUTCOMES
Air embolism can causes respiratory, circulatory and neurological dysfunction. After aggressive treatment, one of the 3 patients died, 1 had permanent visual impairment, and 1 recovered completely without comorbidities.
CONCLUSIONS
While it is common for small amounts of air/air bubbles to enter the circulatory system during endoscopic procedures, life-threatening air embolism is rare. Air embolism can lead to serious consequences, including respiratory, circulatory, and neurological impairment. Therefore, early recognition of severe air embolism and prompt hyperbaric oxygen therapy are essential to avoid its serious complications.
Topics: Adult; Early Medical Intervention; Echocardiography, Transesophageal; Embolism, Air; Endoscopy; Female; Heart; Humans; Hyperbaric Oxygenation; Male; Middle Aged; Patient Care Management; Pulmonary Artery; Risk Assessment; Risk Factors; Severity of Illness Index; Treatment Outcome
PubMed: 34115039
DOI: 10.1097/MD.0000000000026304 -
Zhurnal Voprosy Neirokhirurgii Imeni N.... 2022The author discusses potential intraoperative complications following neurosurgical interventions in sitting position: venous air embolism and paradoxical air embolism,...
The author discusses potential intraoperative complications following neurosurgical interventions in sitting position: venous air embolism and paradoxical air embolism, postural hypotension, pneumocephalus, cervical flexion neuropathy, positional damage to peripheral nerves and others. Naturally, prevention of these complications is also considered, and the most effective approach is surgery in lying position.
Topics: Embolism, Air; Humans; Neurosurgery; Neurosurgical Procedures; Posture; Sitting Position
PubMed: 35758085
DOI: 10.17116/neiro20228603199 -
Proceedings of the National Academy of... Jun 2021An air embolism is induced by intravascular bubbles that block the blood flow in vessels, which causes a high risk of pulmonary hypertension and myocardial and cerebral...
An air embolism is induced by intravascular bubbles that block the blood flow in vessels, which causes a high risk of pulmonary hypertension and myocardial and cerebral infarction. However, it is still unclear how a moving bubble is stopped in the blood flow to form an air embolism in small vessels. In this work, microfluidic experiments, in vivo and in vitro, are performed in small vessels, where bubbles are seen to deform and stop gradually in the flow. A clot is always found to originate at the tail of a moving bubble, which is attributed to the special flow field around the bubble. As the clot grows, it breaks the lubrication film between the bubble and the channel wall; thus, the friction force is increased to stop the bubble. This study illustrates the stopping process of elongated bubbles in small vessels and brings insight into the formation of air embolism.
Topics: Air; Animals; Blood Vessels; Cell Aggregation; Embolism, Air; Friction; Lubrication; Rabbits; Rheology
PubMed: 34155104
DOI: 10.1073/pnas.2025406118 -
BMJ Case Reports Dec 2016Air embolism is often an iatrogenic complication which may occur in venous or arterial circulation depending on the port of entry. We present two cases in which air...
Air embolism is often an iatrogenic complication which may occur in venous or arterial circulation depending on the port of entry. We present two cases in which air embolism occurred in venous and arterial circulation after contrast medium injection (CMI) and coronary artery bypass graft (CABG) surgery, respectively. In one case, accumulation of air bubbles was observed in the pulmonary artery after CMI. This was attributed to inadvertent injection of air owing to improper connection of the injector and the catheter. The patient was managed with 100% oxygen in the Trendelenburg and left lateral decubitus position. Repeat imaging demonstrated resorption of the emboli. In another case, air was introduced during CABG in the left atrium and ventricle. Immediate suction of air was attempted however, the patient developed cardiogenic shock requiring vasopressors, and subsequently seizures and coma due to diffuse ischaemic stroke. The patient eventually expired.
Topics: Aged; Aged, 80 and over; Catheterization, Central Venous; Contrast Media; Coronary Artery Bypass; Embolism, Air; Female; Glucocorticoids; Humans; Infusions, Intravenous; Male; Treatment Outcome
PubMed: 27920021
DOI: 10.1136/bcr-2016-217550 -
Journal of the Neurological Sciences Mar 2016Cerebral gas embolism (CGE) is a potentially catastrophic complication of central venous catheters (CVCs) manipulation or accidental disconnection, which is rarely... (Review)
Review
OBJECTIVE
Cerebral gas embolism (CGE) is a potentially catastrophic complication of central venous catheters (CVCs) manipulation or accidental disconnection, which is rarely reported in the literature. This systematic review aims to characterize the clinical manifestations, imaging features and outcome of CGE associated with CVCs.
METHODS
Systematic literature search of all published cases of CGE associated with CVCs, and identification of previously unreported local cases. Descriptive analysis of all cases, mortality analysis for cases with individualized data.
RESULTS
Of the 158 patients with CGE associated with CVCs found, 71.8% were male and mean age was 56.4years. CGE symptoms frequently occurred while in the upright position. The most frequent neurological manifestation was sudden-onset focal neurological sign (67.7%), followed by coma (59.5%), epileptic seizures (24.7%) and encephalopathy (21.5%). Imaging revealed intracranial air bubbles in 69.1% and cerebral ischemia or edema was demonstrated in 66.7%. Overall mortality was 21.7%, and clinical predictors of mortality were increasing age (p<0.001), coma (p=0.001), cardiorespiratory arrest shortly after symptom onset (p<0.001) and male sex (p=0.035).
CONCLUSIONS
CGE associated with CVCs may mimic ischemic stroke, but patients frequently present a severe vigilance disturbance and epileptic seizures. Mortality occurs in 1/5 of patients, which substantiates implementation of protocols and measures to prevent this severe complication of CVC use.
Topics: Adult; Aged; Central Venous Catheters; Embolism, Air; Female; Humans; Intracranial Embolism; Male; Middle Aged; PubMed
PubMed: 26944140
DOI: 10.1016/j.jns.2016.01.043 -
The British Journal of Radiology Jan 2019Gas does not occur naturally in the cardiovascular system, although it is not unusual to identify it on imaging. The true incidence is difficult to know as asymptomatic... (Review)
Review
Gas does not occur naturally in the cardiovascular system, although it is not unusual to identify it on imaging. The true incidence is difficult to know as asymptomatic cases are rarely recorded. In iatrogenic instance, this occurs when atmospheric air enters the cardiovascular system from a high to low pressure, or when gas is forcibly injected into a vessel. The source of air must be promptly identified and treatment must be expedited to reduce morbidity and mortality. This pictorial review aims to give an overview of the causes (with particular emphasis on the conditions that may be encountered by a Radiologist), appearances of cardiovascular gas, and any subsequent treatment.
Topics: Adult; Aged; Aged, 80 and over; Cardiovascular System; Cause of Death; Diagnostic Imaging; Embolism, Air; Female; Humans; Male; Middle Aged; Risk Assessment; Survival Rate
PubMed: 30028184
DOI: 10.1259/bjr.20180121 -
The American Journal of Nursing Jun 2015The Pennsylvania Patient Safety Reporting System is a confidential, statewide Internet reporting system to which all Pennsylvania hospitals, outpatient-surgery...
The Pennsylvania Patient Safety Reporting System is a confidential, statewide Internet reporting system to which all Pennsylvania hospitals, outpatient-surgery facilities, birthing centers, and abortion facilities must file information on incidents and serious events.Safety Monitor is a column from Pennsylvania's Patient Safety Authority, the authority that informs nurses on issues that can affect patient safety and presents strategies they can easily integrate into practice. For more information on the authority, visit www.patientsafetyauthority.org. For the original article discussed in this column or for other articles on patient safety, click on "Patient Safety Advisories" and then "Advisory Library" in the left-hand navigation menu.
Topics: Central Venous Catheters; Embolism, Air; Humans; Internet; Patient Safety; Pennsylvania; Risk Management
PubMed: 26018011
DOI: 10.1097/01.NAJ.0000466327.76934.a0 -
Journal of Medical Case Reports Feb 2024Intracardiac thrombus and vascular air embolism represent rare complications in the context of orthotopic liver transplantation. While isolated reports exist for...
BACKGROUND
Intracardiac thrombus and vascular air embolism represent rare complications in the context of orthotopic liver transplantation. While isolated reports exist for intracardiac thrombus and vascular air embolism during orthotopic liver transplantation, this report presents the first documentation of their simultaneous occurrence in this surgical setting.
CASE PRESENTATION
This case report outlines the clinical course of a 60-year-old white female patient with end-stage liver disease complicated by portal hypertension, ascites, and hepatocellular carcinoma. The patient underwent orthotopic liver transplantation and encountered concurrent intraoperative complications involving intracardiac thrombus and vascular air embolism. Transesophageal echocardiography revealed the presence of air in the left ventricle and a thrombus in the right atrium and ventricle. Successful management ensued, incorporating hemodynamic support, anticoagulation, and thrombolytic therapy, culminating in the patient's discharge after a week.
CONCLUSIONS
This report highlights the potential for simultaneous intraoperative complications during orthotopic liver transplantation, manifesting at any phase of the surgery. It underscores the critical importance of vigilant monitoring throughout orthotopic liver transplantation to promptly identify and effectively address these rare yet potentially catastrophic complications.
Topics: Humans; Female; Middle Aged; Embolism, Air; Liver Transplantation; Thrombosis; Heart Diseases; Echocardiography, Transesophageal; Intraoperative Complications; Liver Neoplasms; Pulmonary Embolism
PubMed: 38368412
DOI: 10.1186/s13256-024-04376-8 -
Arquivos de Neuro-psiquiatria Dec 2021
Topics: Embolism, Air; Humans; Mesenteric Ischemia; Tomography, X-Ray Computed
PubMed: 34550176
DOI: 10.1590/0004-282X-ANP-2021-0285