Cardiac catheters for diagnosis and treatment of venous air embolism

Abstract

One hundred consecutive patients undergoing neurosurgical procedures in the seated position were monitored for venous air embolism with a Swan-Ganz pulmonary artery (PA) catheter, precordial Doppler ultrasound device, and continuous end-tidal CO2 (FETCO2) analysis. Simultaneous determinations of right atrial and pulmonary capillary wedge pressures were also performed during each operation. Although 80 episodes of air embolism were detected by changes in Doppler sounds, only 36 were associated with increased PA pressure, and only 30 developed a decrease in FETCO2. Changes in PA pressure and FETCO2 agreed closely (r = 0.86), and only marked changes were associated with systemic hypotension. Air was recovered from the right atrium and PA only in small amounts (2 to 20 ml) during air embolism, although it was possible to aspirate large quantities of blood. Twenty-nine patients were found to have right atrial pressures that were higher than pulmonary capillary wedge pressures. Paradoxical air embolism from a probe-patent foramen ovale was possible in these patients, and one developed signs and symptoms of systemic air embolism postoperatively. We conclude that noninvasive monitoring with the combination of a precordial Doppler device and end-tidal CO2 analysis is satisfactory for rapid detection of clinically significant venous air embolism. The unique advantage of Swan-Ganz monitoring, however, is that it permits identification of patients who may sustain paradoxical air embolism, and that it differentiates the hemodynamic effects of brain-stem manipulation from those caused by air embolism.

Anesthesia and Surgery in the Seated Position: Analysis of 554 Cases

“…The overall incidence of VAE (23 %) is consistent with that reported in other series (3,6,22) (Table 12). Before precordial Doppler monitoring, air embolism was detected less often, but the episodes were more severe.…”

“…position, but contend that there is no need to have a central I venous or pulmonary artery catheter in such patients because the incidence and severity of air embolism is negligible (14, i I 17, 28), the complications of catheter insertion are too high (5), or the air recovery with aspiration is insignificant. How I ever, the incidence of venous air embolism (VAE) is signifi cant in some series (3,22), the complications of central catheterization are minimal (6,7), air recovery is considerable (3,20), and mortality and morbidity are low (8). Transeso phageal echocardiography has demonstrated AAE via a patent I foramen ovale in patients without intra-or postoperative sequelae (1O, 13).…”

Intraoperative Visible Bubbling of Air May Be the First Sign of Venous Air Embolism During Posterior Surgery for Scoliosis

“…14 - 16 Bedford et al noted that 80% of neurosurgical procedures done in the sitting position had evidence of air embolism. 17 This high prevalence in this unique neurosurgical setting may have resulted in a false sense of security and unawareness to the possibility of VAE occurring in other surgical procedures. Frankel and Holzman described a case of VAE during posterior spinal fusion the prone position.…”

Tangential Gunshot Wound to the Chest Causing Venous Air Embolism: A Case Report and Review

“…Closed-chest cardiac compressions have also been recommended in the treatment of VAE, as a method to force air out of the pulmonary outflow tract and into small pulmonary vessels (3). Direct removal of air from the venous circulation can be performed through aspiration from a central venous catheter in the right atrium (14,23). In rare cases, massive VAE in trauma patients has been treated successfully with emergency thoracotomy by clamping the hilum of the injured lung to interrupt the continuous entry of air into blood vessels (24,25).…”