Cerebral Air Embolism after Esophagogastroduodenoscopy: Insight on Pathophysiology, Epidemiology, Prevention and Treatment

Ghannam, Malik; Beran, Azizullah; Ghazaleh, Dana; Ferderer, Tanner; Berry, Brent; Banna, Mona Al; Mohl, Leighton; Streib, Christopher; Thacker, Tapan; Matos, Iván Enciso

doi:10.1016/j.jstrokecerebrovasdis.2019.104403

Cited by 9 publications

(11 citation statements)

References 34 publications

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“…Timely hyperbaric O 2 therapy is the definitive treatment as it may decrease the size of air emboli by facilitating gas reabsorption, therefore minimizing air bubbles, reducing cerebral edema, reducing platelet aggregation due to bubble-induced endothelial damage, accelerating nitrogen reabsorption, preventing release of free O 2 radicals, and increasing O 2 concentrations in the blood (improving tissue oxygenation and reducing ischemic reperfusion injury). Timely hyperbaric O 2 therapy administered within the first 5 h increases the chance for full recovery by 50% [ 70 , 71 , 72 ].…”

Section: Discussionmentioning

confidence: 99%

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When in Trouble Think of the Bubble: Paradoxical Cerebral Arterial Gas Embolism after Endoscopic Retrograde Cholangiopancreatography

Ekmektzoglou

Alexandrakis²,

Dimopoulos³

et al. 2021

Case Rep Gastroenterol

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Air embolism (a result of direct communication with the vasculature and an external pressure gradient from the gastrointestinal or the biliary tract), although rare, is a potentially devastating adverse event seen in endoscopic retrograde cholangiopancreatography (ERCP) procedures. Whether venous, arterial, or paradoxical, the clinical presentation ranges from asymptomatic patients to cardiorespiratory arrest. This is of particular importance because it makes the diagnosis of air embolism even more difficult in an already sedated patient. Since early recognition increases the chances of patients’ survival, endoscopists should be highly motivated and trained to recognize this complication as early as possible. With only 60 cases of air embolism reported (and even fewer related to paradoxical air embolism), we aimed to report a case of paradoxical cerebral air embolism in a patient undergoing ERCP due to a common bile duct stricture and to provide a mini-review of this clinical entity that can serve as a bedside quick reference guide for endoscopists worldwide.

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Section: Discussionmentioning

confidence: 99%

“…Firstly, the importance of performing ERCPs only when clinically indicated cannot be overstated enough; by not overperforming ERCPs, the incidence of peri-ERCP adverse effects is kept to a minimum. Regarding patients per se, optimizing their volume status and maintaining normovolemia can prevent air embolism during the endoscopy [ 70 ].…”

Section: Discussionmentioning

confidence: 99%

When in Trouble Think of the Bubble: Paradoxical Cerebral Arterial Gas Embolism after Endoscopic Retrograde Cholangiopancreatography

Ekmektzoglou

Alexandrakis²,

Dimopoulos³

et al. 2021

Case Rep Gastroenterol

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“…Overall, there does appear to be around a few hundred cases reported of iatrogenic cerebral air embolism, as seen in a systematic review by Hatling et al [3]. Otherwise, many reports exist wherein iatrogenic air emboli have occurred secondary to central venous catheter removal, endoscopic procedures, trauma, deep sea diving, and surgical procedures, especially upright neurosurgical or otorhinolaryngological procedures [2][3][4][5][6][7][8][9]. e presence of a PFO in these cases is not as well described.…”

Section: Discussionmentioning

confidence: 99%

“…Reportedly, somewhere around 20,000 cases of cerebral air embolism occur each year [1], often presenting as an arterial or venous embolism, but usually not both. Many cerebral air embolism cases present from an iatrogenic cause, such as central venous access insertion or removal, surgical procedures particularly neurosurgical and cardiothoracic procedures, or trauma [2][3][4][5][6][7][8][9]. Additionally, arterial emboli can be seen from venous air introduction, especially if an intracardiac shunt is present, as a paradoxical embolus [2,3,[10][11][12][13][14][15][16][17][18].…”

Section: Introductionmentioning

confidence: 99%

Paradoxical and Retrograde Air Embolism from Pressurized Peripheral Bolus

Santucci

Mullaguri

Battineni

et al. 2021

Case Reports in Neurological Medicine

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Introduction. Cerebral air embolism is a rare, yet serious neurological occurrence with unclear incidence and prevalence. Here, we present a case of fatal cerebral arterial and venous cerebral gas embolism in a patient with infective endocarditis and known large right-to-left shunt and severe tricuspid regurgitation following pressurized fluid bolus administration. Case Presentation. A 32-year-old female was admitted to the medical intensive care unit from a long-term acute care facility with acute on chronic respiratory failure. Her medical history was significant for intravenous heroin and cocaine abuse, methicillin-sensitive Staphylococcus aureus tricuspid valve infective endocarditis on vancomycin, patent foramen ovale, septic pulmonary embolism with cavitation, tracheostomy with chronic ventilator dependence, multifocal cerebral infarction, hepatitis C, nephrolithiasis, anxiety, and depression. After intravenous fluid administration, she became unresponsive with roving gaze, sluggish pupils, and hypotensive requiring vasopressors. CT of the brain showed diffuse arterial and venous cerebral air embolism secondary to accidental air administration from fluid bolus. Magnetic resonance imaging of the brain showed diffuse global anoxic injury and flattening of the globe at the optic nerve insertion. Given poor prognosis, her family chose comfort measures and she died. Conclusions. Fatal cerebral air embolism can occur through peripheral intravenous routes when the lines are inadequately primed and fluids administered with pressure. Caution must be exercised in patients with right-to-left shunting as air may gain access to systemic circulation.

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“…Computed tomography is usually the test that reveals the diagnosis, with endoscopy being contra-indicated due to risk of air embolization from insufflation during the examination. 20 Preferred treatment is surgical repair with a limited role for esophageal stenting if the process is recognised in its early stages.…”

Section: Clinical Features and Incidencementioning

confidence: 99%

Preventing esophageal complications from atrial fibrillation ablation: A review

et al. 2021

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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Cerebral Air Embolism after Esophagogastroduodenoscopy: Insight on Pathophysiology, Epidemiology, Prevention and Treatment

Cited by 9 publications

References 34 publications

When in Trouble Think of the Bubble: Paradoxical Cerebral Arterial Gas Embolism after Endoscopic Retrograde Cholangiopancreatography

When in Trouble Think of the Bubble: Paradoxical Cerebral Arterial Gas Embolism after Endoscopic Retrograde Cholangiopancreatography

Paradoxical and Retrograde Air Embolism from Pressurized Peripheral Bolus

Preventing esophageal complications from atrial fibrillation ablation: A review

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