Cardiac Arrest as a Consequence of Air Embolism: A Case Report and Literature Review

Abstract

Air embolism is an infrequent but potentially catastrophic complication. It could be a complication of invasive procedures including surgery, central line placement, positive pressure ventilation, trauma, hemodialysis, pacemaker placement, cardiac ablation, and decompression sickness. Usually, it does not cause any hemodynamic complication. In rare cases, it could lodge in the heart and cause cardiac arrest. We present a case of an 82-year-old white female who underwent computed tomography (CT) guided biopsy of right lung pulmonary nodule. When she was turned over after the lung biopsy, she became unresponsive and developed cardiopulmonary arrest. She underwent successful resuscitation and ultimately was intubated. CT chest was performed immediately after resuscitation which showed frothy air dense material in the left atrium and one of the right pulmonary veins suggesting a Broncho venous fistula with air embolism. Although very rare, air embolism could be catastrophic resulting in cardiac arrest. Supportive care including mechanical ventilation, vasopressors, volume resuscitation, and supplemental oxygen is the initial management. Patients with cardiac, neurological, or respiratory complications benefit from hyperbaric oxygen therapy.

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

“… 13 , 14 Conversely, three patients developed cardiac arrest during or moments after the biopsy but due to extensive and immediate cardiac resuscitation, the patients survived. 15 - 17 No patients developed cardiac arrest as secondary symptoms or hours after the procedure.…”

“…13,14 Conversely, three patients developed cardiac arrest during or moments after the biopsy but due to extensive and immediate cardiac resuscitation, the patients survived. [15][16][17] No patients developed cardiac arrest as secondary symptoms or hours after the procedure. We found a divergent association between the location of the air embolisms and the patients' symptomsinitial or secondary.…”

A life-threatening condition: The pulmonary artery air embolism

“…Also, body position may worsen the symptoms 8 . Dyspnea, tachypnea, wheezing, chest pain, high central venous distension, hypotension, respiratory failure, and shock-like appearance could occur when large amounts of air enter into the pulmonary circulation in the air embolism 9 . Any of sudden cardiovascular, respiratory and/or neurological problems after high-risk invasive procedures should prompt the suspicion of pulmonary air embolism 10 .…”

Cardiac Arrest Due to Air Embolism: Complicating Image-guided Lung Biopsy

“…To our knowledge, only a few cases of fatal cardiac arrest complicating transthoracic lung biopsy have been reported in the literature. Most of the times, these patients had multiple cancer metastases, chronic diseases, or had hemoptysis or cough during the needle biopsy, which could have led to cardiac air embolism [ 16 - 20 ]. Nevertheless, we think that cardiac air embolism during CT guided lung biopsy is a rare adverse event, but its true incidence is probably underestimated.…”