Cerebral Arterial Air Embolism After Endobronchial Electrocautery: A Case Report and Review of the Literature 

Abstract

Background: Endobronchial electrocautery is a common and safe therapeutic endoscopic treatment for malignant airway obstruction. Cerebral arterial air embolism (CAAE) is a rare but potentially fatal complication of endobronchial electrocautery.Case presentation: We present the first case of cerebral arterial air embolism after endobronchial electrocautery. A 56-year-old male with a pulmonary tumor in the right upper lobe received a repeated endobronchial electrocautery. During the procedure, he experienced unresponsive, hypoxemic, bradycardic and developed tetraplegia. The brain computer tomography showed several cerebral arterial air emboli with low-density spots in the right frontal lobe. He received hyperbaric oxygen therapy with almost full recovery except resident left-sided weakness.Conclusions: General physicians should realize that CAAE can be a possible complication of endobronchial electrocautery. Some measures could be used to prevent this devastating complication: avoiding positive pressure, lowering ventilatory pressures if possible, avoiding advancing the bronchoscope to occlude the bronchus, and using the non-contact technique etc.