Cardiac Arrest due to Left Ventricular Gas Embolism After Bronchoscopic Argon Plasma Coagulation: A Case Report

Goldman, Yaron; Panzica, Peter; Pinto, Duane S.; Delatorre, Ralph; Feller‐Kopman, David; Ernst, Armin

doi:10.1097/01.lbr.0000212547.17588.8c

Cited by 10 publications

(12 citation statements)

References 9 publications

(6 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Of note, in all 3 cases reported by Reddy et al [3,7], APC was used to terminate endobronchial bleeding, as was the case for our patient. Bleeding may represent an airway-pulmonary venous communication, affording a direct conduit for cooling or argon gas to enter into the left heart.…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, while both of these thermal modalities have established track records of safety, serious complications such as systemic gas embolization have been reported in association with their use [3,5,6]. Bronchoscopically delivered APC has been specifically reported to be complicated by systemic gas embolism to the left ventricle and cardiodynamic collapse requiring cardiopulmonary resuscitation [3,7]. An extensive review of the published English-language literature yielded no reports of cerebral gas embolism due to bronchoscopic APC use.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Cerebral Gas Embolism from Bronchoscopic Argon Plasma Coagulation: A Case Report

Shaw¹,

Yoneda²,

Chan³

2011

Respiration

View full text Add to dashboard Cite

Argon plasma coagulation (APC) is a common and safe bronchoscopic technique used in the management of obstructing lesions and hemorrhage in the central airways. Complications of bronchoscopic APC are uncommon and include hemorrhage, perforation and fire in the airways. While bronchoscopic APC has been reported to cause systemic gas embolization and associated cardiovascular collapse, we report a case of cerebral gas embolization that occurred during bronchoscopic APC and highlight underappreciated potential risk factors for its occurrence.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cerebral Gas Embolism from Bronchoscopic Argon Plasma Coagulation: A Case Report

Shaw¹,

Yoneda²,

Chan³

2011

Respiration

View full text Add to dashboard Cite

show abstract

“…Moreover, there is increasing evidence of gas embolization occurring with the utilization of argon plasma coagulation, as was experimentally confirmed by Feller-Kopman et al [8] in an animal model. The exact mechanism is unclear at present, but it has been suggested that small airway-venous fistulas are created through which positive pressure or jet ventilation may force air into the vasculature [8][9][10][11] .…”

Section: Discussionmentioning

confidence: 99%

Fatal Cerebral Air Embolism following Uneventful Flexible Bronchoscopy

et al. 2010

View full text Add to dashboard Cite

needle aspiration and transbronchial biopsy, resulting in a frequency of ! 0.02% for this severe complication in our institution. In addition to early supportive measures, 1 patient received hyperbaric oxygen therapy as further treatment. Prompt recognition of this complication is mandatory in order to implement appropriate supportive measures. Highflow oxygen should be administered and hyperbaric oxygen therapy may be considered, if available. If possible, positive pressure ventilation should be avoided. AbstractFlexible bronchoscopy is a widely used and safe procedure with a reported maximal mortality rate of 0.04% and a majorcomplications rate of 0.5%. There are, however, only few case descriptions for postinterventional cerebral air embolism and the frequency of this supposedly rare complication is unknown. The current study presents 2 patients with nonsmall cell lung cancer who suffered fatal cerebral air embolism following diagnostic bronchoscopy with transbronchial Established Facts• Flexible bronchoscopy is a frequently used and safe procedure with reported rates of mortality, major complications, and minor complications of 0.1, 1.7, and 6.5%, respectively. • Cerebral embolism following transbronchial needle aspiration and/or transbronchial biopsy is an exceedingly rare complication of unknown frequency. Novel Insights• We herein report 2 cases of seemingly uneventful bronchoscopies that resulted in fatal cerebral air embolism.• Although this complication occurred with a frequency of ! 0.02% in our institution, every bronchoscopist should recognize this severe adverse event in order to initiate prompt supportive measures and consider hyperbaric oxygen therapy.

show abstract

“…Ici, avec ce type de technologie, le principal risque est d'introduire encore plus activement de l'argon dans la circulation générale mais l'emploi de cet outil permet aussi bien des cautérisations/coagulations sur des vaisseaux lors d'interventions que des biopsies nécessitant un contrôle des épanche-ments sanguins [33]. Toutefois, des problèmes lors de l'usage de la coagulation par faisceau de plasma d'argon ont conduit à des emphysèmes sous-cutanés [34], des arrêts cardiaques en cours d'opération [35,36] via des embolies gazeuses [37][38][39][40][41] pouvant s'avérer mortelles [41][42][43]. Le principal facteur géné-rateur d'embolie avec ce système demeure le débit d'argon employé [44].…”

Section: Argon Et Accidents Médicauxunclassified

“…Sa concentration (0,93 %) le rend plus de 27 fois plus abondant que le dioxyde de carbone (0,035 %). La quasi-totalité de l'argon terrestre est l'isotope 40 Ar (99,6 %), provenant de la dégra-dation du potassium 40 K dans la croûte terrestre, suivi par les isotopes 36 Ar (0,34 %) et 38 Ar (0,06 %). Cependant, la forme la plus abondante de l'argon dans l'univers est l'isotope 36 Ar, formé dans la nucléosynthèse stellaire des supernovas.…”

Section: Introductionunclassified

L’argon : utilisations, toxicité et stratégie analytique en toxicologie médicolégale

2012

View full text Add to dashboard Cite

Résumé -Bien qu'intrinsèquement non toxiques, les gaz nobles comme l'argon entraînent à fortes concentrations une déplétion d'oxygène pouvant mener jusqu'à l'asphyxie. Si l'argon se retrouve dans la circulation générale, celui-ci peut même être responsable d'embolies parfois fatales. Cependant, les propriétés d'inerties physicochimiques de ce gaz le rendent très utile dans de nombreuses applications actuelles. Ces applications étant en constante augmentation, il n'est pas rare d'observer proportionnellement des intoxications parfois létales liées à ce gaz. Ainsi, devant le manque d'harmonisation des prélèvements d'échantillons biologiques afin de mettre en évidence de telles intoxications aux gaz nobles et devant l'augmentation du nombre de cas, il devient nécessaire d'établir un état des lieux sur l'utilisation de l'argon, sa toxicité et la stratégie analytique à adopter dans le contexte médico-légal. Mots clés :Argon, gaz noble, échantillonnage de gaz, analyse de gaz Abstract -Even though noble gases such as argon are intrisically non-toxic, they will enhance an oxygen-depletion at high concentrations. This depletion may lead to asphyxia. If argon is found in blood flow, it could be responsible of an embolism. However, its inert physicochemical properties appear to be very useful to a wide range of current applications. The rise of these applications induces a proportionnal increase of lethal intoxications due to this gas. Thus, as no standardization of biological samples exists, and knowing the increase of argon intoxication cases, it seems necessary to establish an incoming inventory of fixture concerning the use of argon. It will confirm its toxicity properties and will highlight other intoxications due to noble gas. This should lead to a new analytical strategy suitable to the forensic context.

show abstract

Cardiac Arrest due to Left Ventricular Gas Embolism After Bronchoscopic Argon Plasma Coagulation: A Case Report

Abstract: Background: Argon plasma coagulation (APC) has been used safely in interventional pulmonology and is rarely associated with morbidity and mortality. We report a case of gas embolism to the left ventricle after bronchoscopy with APC.

Cited by 10 publications

References 9 publications

Cerebral Gas Embolism from Bronchoscopic Argon Plasma Coagulation: A Case Report

Cerebral Gas Embolism from Bronchoscopic Argon Plasma Coagulation: A Case Report

Fatal Cerebral Air Embolism following Uneventful Flexible Bronchoscopy

L’argon : utilisations, toxicité et stratégie analytique en toxicologie médicolégale

Contact Info

Product

Resources

About