Veno-arterial extracorporeal membrane oxygenation for the treatment of obstructive shock caused by venous air embolism:A case report

BACKGROUND Venous air embolism(VAE)is a potentially lethal condition,with a reported incidence rate of about 0.13%,and the true incidence may be higher since many VAE are asymptomatic.The current treatments for VAE include Durant's maneuver,aspiration and removal of air through venous catheters,and hyperbaric oxygen therapy.For critically ill patients,use of cardiotonic drugs and chest compressions remain useful strategies.The wider availability of extracorporeal membrane oxygenation(ECMO)has brought a new option for VAE patients.CASE SUMMARY A 53-year-old female patient with VAE presented to the emergency clinic due to abdominal pain with fever for 1 d and unconsciousness for 2 h.One day ago,the patient suffered from abdominal pain,fever,and diarrhea.She suddenly became unconscious after going to the toilet during the intravenous infusion of ciprofloxacin 2 h ago,accompanied by nausea and vomiting,during which a small amount of gastric contents were discharged.She was immediately sent to a local hospital,where cranial and chest computed tomography showed bilateral pneumonia as well as accumulated air visible in the right ventricle and pulmonary artery.The condition deteriorated despite endotracheal intubation,rehydration,and other treatments,and the patient was then transferred to our hospital.Veno-arterial ECMO was applied in our hospital,and the patient's condition gradually improved.The patient was successfully weaned from ECMO and extubated after two days.CONCLUSION ECMO may be an important treatment for patients with VAE in critical condition.

Fatal left atrial air embolism as a complication of percutaneous transthoracic lung biopsy:A case report

BACKGROUND Computed tomography(CT)-guided percutaneous lung biopsy is a common protocol in the context of diagnostic thoracic oncology,but entails a risk of complications including systematic air embolism(SAE).While SAE is often well tolerated,it can be difficult to treat and may result in rapid mortality in some cases.CASE SUMMARY We report a rare case of left atrial SAE in a 71-year-old woman who underwent a CT-guided lung biopsy of a pulmonary nodule in the posterior basal segment of the right lower lobe.Shortly following needle extraction,she experienced a mild cough,hemoptysis,rapid-onset unconsciousness,and cardiopulmonary arrest.Cardiopulmonary resuscitation was immediately performed,but the patient died 40 min after the procedure.A closer review of collected CT scans revealed the presence of a large volume of air within the left atrium.CONCLUSION Although SAE is generally well tolerated and asymptomatic,interventional radiologists must be aware of the risk of fatal outcomes and establish appropriate emergency management protocols.In this report,the characteristics,mechanisms,and treatment recommendations associated with SAE are discussed in an effort to improve the survival of affected patients.

Suspected cerebrovascular air embolism during endoscopic esophageal varices ligation under sedation with fatal outcome: A case report

BACKGROUND Air embolism is a very rare,yet serious and potentially fatal complication of digestive endoscopic treatment.Air embolism is the result of air directly entering the arteries or veins.However,to recognize neurological dysfunction under sedation can be difficult.Therefore,it is extremely important to identify high-risk groups and take preventive measures.CASE SUMMARY Herein,we report a 74-year-old female patient with esophageal varices who suffered from consciousness disturbance after the third endoscopic ligation of esophageal varices under sedation.Combined with the patient’s imaging examination results and medical history,we highly suspected that the patient had developed paradoxical cerebral air embolism during endoscopic ligation.We learned that the patient died at a later follow-up.In order to be able to identify and prevent the occurrence of air embolism early,we summarize and analyze the risk factors,pathogenesis,clinical manifestations,prevention and treatment options of gastrointestinal endoscopy complicated by cerebral air embolism.CONCLUSION Electroencephalographic monitoring helps to recognize the occurrence of air embolism in time and increase the patient's chance of survival.

Successful treatment of intracardiac air embolism using intracardiac catheter aspiration

Intracardic air embolism is uncommon, however it is a serious condition which frequently leads to catastrophic complications during or after invasive procedures resulting in significant morbidity and mortality. For a successful re- suscitation of patients with intracardiac air embolism, hy- perbaric oxygen therapy is critical.~~2~ Still, due to a hyper- baric chamber＇s unavailability at many hospitals and con- cerns about patient movement resulting in further embolism during transport, such treatment method is gradually dimin- ishing.

Cerebral air embolism complicating transbronchial lung biopsy: A case report

BACKGROUND In this case report we describe an extremely rare case of cerebral air embolism following transbronchial lung biopsy(TBLB).Only a few cases of this rare complication were described previously.Every bronchologist should recognize this severe adverse event.Prompt recognition of this complication is mandatory in order to initiate supportive measures and consider hyperbaric oxygen therapy.CASE SUMMARY In this case report we describe an extremely rare case of cerebral air embolism following TBLB.Only a few cases of this rare complication were described previously.Our patient had an incidental finding of lung tumour and pulmonary emphysema.Cerebral air embolism developed during bronchoscopy procedure,immediately after the third trans-bronchial lung biopsy sample and caused cerebral ischaemia of the right hemisphere and severe left-sided hemiplegia.Despite timely initiation of hyperbaric oxygen therapy hemiplegia didn´t resolve and the patient died several weeks later.Cerebral air embolism is an extremely rare complication of TBLB.This condition should be considered in case the patient remains unresponsive or presents with acute neurological symptoms in the postintervention period since early recognition,diagnosis and hyperbaric oxygen therapy initiation are key factors determining the patient´s outcome.CONCLUSION Within this report,we conclude that air/gas embolism is an extremely rare complication after TBLB,which should be considered in case the patient remains unresponsive or presents with acute neurological symptoms in the postintervention period after bronchoscopy.The current gold standard for diagnosis is computed tomography scan of the head.After recognition of this complication we suggest immediate hyperbaric oxygen therapy,if available.

Fatal air embolism during endoscopic retrograde cholangio-pancreatography (ERCP): a case report

A 61-year-old woman was diagnosed with common bile duct stones and acute biliary pancreatitis. She had previously undergone cholecystectomy 5 years ago. A planed endoscopic retrograde cholangio-pancreatography (ERCP) was arranged under general anesthesia. The patient was posed at prone position without bronchial intubation. Endoscopic access was achieved smoothly and cholangiography revealed mild dilation of the extrahepatic bile duct with mild graduate taper at ampullary region. Some filling defects were found inside lower CBD. A moderate sphincterotomy was made unremarkably, and some tiny stones were retrieved using a Dormia basket. A retrieval balloon was advanced into bile duct to make occlusion cholangiogram. At this moment, the endoscope lost its location into part one of duodenum. When the scope reaches back to descending duodenum, active bleeding was found coming out from orifice of papilla, accompanied with decreased oxygen saturation and arrhythmia. X-ray examination demonstrated gas within hepatic vein and inferior cava vein, although no free gas was observed in the renal region or subphrenic area. The endoscope was removed immediatelyand patient was changed to supine position. Vigorous cardiopulmonary resuscitation was begun immediately, unfortunately the patient did not response to all the efforts. The causes of death were thought to be systemic air embolism with cardiopulmonary failure.

Systemic air embolism associated with endoscopic retrograde cholangiopancreatography: A case report

BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)is a key procedure for diagnosing and treating biliary and pancreatic disorders.Although effective,it carries risks,including rare but severe complications such as air embolism.CASE SUMMARY We report a case of a 58-year-old man who developed extensive air embolism during ERCP.He previously underwent a Whipple procedure and experienced a sudden drop in vital signs and loss of consciousness.Immediate intervention with hyperbaric oxygen therapy and supportive care led to gradual recovery.Imaging confirmed widespread air embolism,which resolved with continued treatment.CONCLUSION Air embolism is a rare,critical complication of ERCP,especially in patients with prior surgery such as pancreaticoduodenectomy.Early detection and prompt treatment,including hyperbaric oxygen therapy,are crucial for favorable out-comes.

TEE monitoring for RA-horizontal paradoxical arterial air embolism during sitting-position surgery

A 36-year-old woman suffered meningioma in her right cerebellopontine angle.Air embolisms often complicate sitting-position surgeries.Because TEE guides the localization of central venous catheters and promptly locates air embolisms promptly enough for effective treatment,TEE is an effective monitoring method for sitting-position surgeries.

Systemic air embolism complicating upper gastrointestinal endoscopy:a case report with post-mortem CT scan findings and review of literature

Endoscopy of the gastrointestinal and biliary tract is a common procedure and is routinely performed for therapeutic and diagnostic purposes.Perforation,bleeding and infection are some of the more common reported side effects.Air embolism on the other hand,is a rare complication of gastrointestinal endoscopy.We report a 77-year-old African-American female with a history of pancreatic cancer,which was resected with a Whipple procedure.As part of diagnostic and therapeutic procedure,an endoscopic retrograde cholangiopancreatography was planned several months after the surgery.The patient’s heart rate suddenly slowed to 40 bpm during the procedure and she became cyanotic and difficult to oxygenate after the endoscope was introduced and CO2 gas was insufflated.A forensic autopsy was performed with post-mortem computed tomography(PMCT)and revealed extensive systemic air embolism.The detailed PMCT and autopsy findings are presented and current literature is reviewed.

Could cough be an intraoperative indicator for venous air embolism in deep brain stimulation surgeries?: experiences from a large case series

Background:Deep brain stimulation (DBS) surgery is usually performed with the patients located in a half-sitting position.Therefore,complications associated with such position accompany,such as venous air embolism (VAE),et al.However,because the patients are fully conscious during the surgery,they may have observable manifestations related to the complications that are otherwise inconspicuous in generally anesthetic surgeries.Thus,we designed this study to investigate the intraoperative manifestations of the potentially dangerous complication of VAE in the DBS surgery.Methods:The medical records of a series of 705 consecutive patients who underwent DBS surgery in our hospital have been retrospectively reviewed.The clinical features,intraoperative manifestations and treatment of these patients were analyzed for evidence of VAE.The correlation between the cough intensity and other clinical features were investigated.Results:Evidence of VAE were found in 16 patients.Statistical analyses showed that severe cough is associated with greater age (p =0.045),longer coughing time (p =0.001),more intensive tremor (p =0.032),more complaints (p =0.036),greater influences (p =0.009),more treatment (p =0.003) and longer hospitalization (p =0.003).Conclusions:Intraoperative intense and unremitting cough may be a noticeable indicator of possible VAE.Early recognition and effective management are essential to prevent unfavorable outcomes in such cases.

Case of Fatal Air Embolism during Double‑J Ureteral Stent Placement

Air embolism is a severe and fatal complication,but it is very rare during transurethral surgery.This report describes a case of air embolism during double‑J ureteral stent placement in a 45‑year‑old woman.During ureteroscopy,a sudden decrease in oxygen saturation and end‑expiratory carbon dioxide pressure and cyanosis of the face were observed.Subsequent echocardiography confirmed an air embolism by detecting bubbles in the heart.Despite resuscitative measures,the patient died rapidly.Detailed autopsy was performed to clarify the cause of death and the route of air entering into the circulatory system.The report presented here reminds urologists and pathologists that air embolism can occur during double‑J ureteral stent placement and offers some suggestions regarding identification of air embolism at autopsy.

A fatal case of oxygen embolism in a hospital

This case reports on a 68-year-old man who was found dead in hospital next to his bed.Before this,he had been treated with intravenous antibiotics for pneumonia.The body was found with a peripheral venous catheter connected to a nasal cannula delivering oxygen(O_(2))from the wall.Extensive medico-legal examinations were performed,including post-mortem computed tomography(CT),complete conventional autopsy,histological and immunohistochemistry analysis,toxicological analysis and post-mortem chemistry.Additionally,CT-guided gas sampling was performed at multiple sites to collect samples for gas analysis.During the external examination,massive subcutaneous emphysema was visible over the entire surface of the body.The CT scan revealed the presence of gas throughout the vascular system,and in the subcutaneous and muscular tissues.The autopsy confirmed the presence of lobar pneumonia and multiple gas bubbles in the vascular system.The gas analysis results showed a subnormal concentration of oxygen,confirming the suspected pure O_(2) embolism.Moreover,the carbon dioxide(CO_(2))concentration in the gas sample from the heart was elevated to a level similar to those found in scuba diving fatalities.This could come from degassing of dissolved CO_(2) that accumulated and was trapped in the cardiac cavity.Based on the results of the different exams performed,and especially the gas analysis results,it was concluded that the cause of death was O_(2) embolism.

Laparoscopic left hemihepatectomy under occlusion of the left inflow and outflow

Laparoscopic hepatectomy seems to be difficult because of the ease of bleeding from the liver parachyma during resection. This is not easily controlled under the laparoscope, especially during right or left hemihepatectomy, except for resection of the peripheral liver or left lateral segment when porta hepatis dissection is not indicated. Although both inflow and outflow control seems to be ideal in laparoscopic left hepatectomy, there have not been many reports of this. In addition to the high technical demands and the time required, any injury of the main hepatic veins or vena cava during the procedure will cause catastrophic bleeding and air embolism. Recently, we succeeded in achieving inflow and outflow occlusion during laparoscopic left hemihepatectomy in four cases, with satisfactory results.

Evaluation of Hysteroscopic-guided Removal of Intrauterine Device in Shanghai: A Report of Four Dead Cases

Objective To analyze the possible cause leading to death during the procecture oy IUD removal under hysteroscopy and how it could be prevented. Methods All （11 110） cases of IUD removal under hysteroscopy performed at 87 hospitals in Shanghai from 2001 to 2007 were reviewed. Four dead cases were reported. Results Air embolism was suspected as the cause of death. Associated risk factors included insufficient preoperative preparation, short duration between surgeries, non-standard procedure, careless observation and untimely resuscitation. Conclusion This emphasizes the necessity of early interventions taken such as prevention, early detection and management of the fatal complications.