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      Air Embolism: Practical Tips for Prevention and Treatment

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          Abstract

          Air embolism is a rarely encountered but much dreaded complication of surgical procedures that can cause serious harm, including death. Cases that involve the use of endovascular techniques have a higher risk of air embolism; therefore, a heightened awareness of this complication is warranted. In particular, central venous catheters and arterial catheters that are often placed and removed in most hospitals by a variety of medical practitioners are at especially high risk for air embolism. With appropriate precautions and techniques it can be preventable. This article reviews the causes of air embolism, clinical management and prevention techniques.

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          Diagnosis and treatment of vascular air embolism.

          Marek Mirski, Abhijit Lele, L. Fitzsimmons … (2006)
          Vascular air embolism is a potentially life-threatening event that is now encountered routinely in the operating room and other patient care areas. The circumstances under which physicians and nurses may encounter air embolism are no longer limited to neurosurgical procedures conducted in the "sitting position" and occur in such diverse areas as the interventional radiology suite or laparoscopic surgical center. Advances in monitoring devices coupled with an understanding of the pathophysiology of vascular air embolism will enable the physician to successfully manage these potentially challenging clinical scenarios. A comprehensive review of the etiology and diagnosis of vascular air embolism, including approaches to prevention and management based on experimental and clinical data, is presented. This compendium of information will permit the healthcare professional to rapidly assess the relative risk of vascular air embolism and implement monitoring and treatment strategies appropriate for the planned invasive procedure.
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            Iatrogenic cerebral air embolism: importance of an early hyperbaric oxygenation.

            K Henriette, M Deleflie, A Boussuges … (2002)
            To assess the relationship between the time period before hyperbaric oxygenation therapy (HBO) and clinical outcome in patients with iatrogenic cerebral air embolism. Retrospective study in a hyperbaric chamber and medical intensive care unit of a university hospital. All patients with air embolism from 1980 to 1999. We retrieved the cases of 86 patients who benefited from an identical HBO and analyzed the relationship between the time period before HBO and clinical outcome. Patients treated with HBO less than 6 h had a better outcome than those treated later. In patients treated within this delay the cause was venous air embolism in 84% and arterial air embolism in only 16% of cases. After this delay the cause was venous air embolism (53%) and arterial air embolism (47%). Patients with venous air embolism and recovery had a shorter delay than patients with sequelae or death (2 h 15 min vs. 4 h). Patients with venous air embolism treated less than 6 h had a better outcome than those treated later. In patients with arterial air embolism the time period before HBO was longer than in venous air embolism (8 h vs. 3 h) and the outcome worse (recovery in 35% vs. 67%). In patients with arterial air embolism no difference in the time period was found between patients with recovery and sequelae or death. We stress the beneficial effect of an early HBO in air embolism, the importance of an increased awareness of physicians concerned with this severe complication, and the need to develop techniques to detect air emboli in the cerebral circulation.
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              Acute management of vascular air embolism

              Nissar Shaikh, Firdous Ummunisa (2009)
              Vascular air embolism (VAE) is known since early nineteenth century. It is the entrainment of air or gas from operative field or other communications into the venous or arterial vasculature. Exact incidence of VAE is difficult to estimate. High risk surgeries for VAE are sitting position and posterior fossa neurosurgeries, cesarean section, laparoscopic, orthopedic, surgeries invasive procedures, pulmonary overpressure syndrome, and decompression syndrome. Risk factors for VAE are operative site 5 cm above the heart, creation of pressure gradient which will facilitate entry of air into the circulation, orogenital sex during pregnancy, rapid ascent in scuba (self contained underwater breathing apparatus) divers and barotrauma or chest trauma. Large bolus of air can lead to right ventricular air lock and immediate fatality. In up to 35% patient, the foramen ovale is patent which can cause paradoxical arterial air embolism. VAE affects cardiovascular, pulmonary and central nervous system. High index of clinical suspicion is must to diagnose VAE. The transesophgeal echocardiography is the most sensitive device which will detect smallest amount of air in the circulation. Treatment of VAE is to prevent further entrainment of air, reduce the volume of air entrained and haemodynamic support. Mortality of VAE ranges from 48 to 80%. VAE can be prevented significantly by proper positioning during surgery, optimal hydration, avoiding use of nitrous oxide, meticulous care during insertion, removal of central venous catheter, proper guidance, and training of scuba divers.
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                Author and article information

                Contributors
                Bernhard Rauch: Role: Academic Editor
                Journal
                Journal ID (nlm-ta): J Clin Med
                Journal ID (iso-abbrev): J Clin Med
                Journal ID (publisher-id): jcm
                Title: Journal of Clinical Medicine
                Publisher: MDPI
                ISSN (Electronic): 2077-0383
                Publication date (Electronic): 31 October 2016
                Publication date Collection: November 2016
                Volume: 5
                Issue: 11
                Electronic Location Identifier: 93
                Affiliations
                [1 ]Massachusetts General Hospital, Harvard Medical School, Division of Interventional Radiology, 55 Fruit Street, GRB-290A, Boston, MA 02114, USA; colin.mccarthy@ 123456mgh.harvard.edu
                [2 ]Mayo Clinic Arizona, Division of Vascular & Interventional Radiology, Phoenix, AZ 85054, USA; Behravesh.sasan@ 123456mayo.edu (S.B.); Naidu.Sailen@ 123456mayo.edu (S.G.N.)
                Author notes
                [* ]Correspondence: oklu.rahmi@ 123456mayo.edu ; Tel.: +1-480-342-1650
                Article
                Publisher ID: jcm-05-00093
                DOI: 10.3390/jcm5110093
                PMC ID: 5126790
                PubMed ID: 27809224
                SO-VID: d7402984-4ba2-42a3-9aa4-aa7683bfef32
                Copyright © © 2016 by the authors; licensee MDPI, Basel, Switzerland.
                License:

                This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC-BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                Date received : 18 September 2016
                Date accepted : 27 October 2016
                Categories
                Subject: Review

                Keywords: air embolism,endovascular,catheter,embolization
                Data availability:
                Keywords: air embolism, endovascular, catheter, embolization

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