Delayed Hyperbaric Treatment of Cerebral Air Embolism

Mader, Jon T.

doi:10.1001/archneur.1979.00500440074015

Cited by 53 publications

(16 citation statements)

References 14 publications

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“…Although the repeat CT scan following completion of HBR therapy showed resolution of the air densities, the patient did not benefit clinically, probably because HBR therapy was not initiated soon enough (6 hours after the ictus). Response to HBR therapy is variable, in that resolution of neurological deficits has been reported when HBR was delayed as long as 29 hours after the onset of symptoms [2].…”

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confidence: 99%

Confirmation of cerebral air embolism with computerized tomography

Hwang¹,

Fremaux²,

Sears³

et al. 1983

Annals of Neurology

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Paradoxical cerebral air embolism is an unusual complication following insertion of a subclavian intravenous catheter. We report an ultimately fatal case in a 75-year-old man in whom the diagnosis was confirmed by computerized tomographic (CT) scanning. W e postulate that air passed through a physiologically closed but anatomically patent foramen ovale.A 75-year-old black man with an ileocutaneous fistula had an alimentation catheter inserted into the right subclavian vein while in the Trendelenburg position. After completion of the maneuver and assumption of a sitting position, the patient became unresponsive in midsentence. Neurological evaluation revealed right conjugate gaze preference with full conjugate excursion to the left upon left caloric stimulation with cold water. The patient was not responsive to verbal stimulation; noxious stimulation caused decerebrate posturing on the right. All extremities were rigid. Deep tendon reflexes were symmetrically hyperactive and plantar responses were bilaterally extensor.A chest radiograph showed neither pneumothorax nor hemothorax, and the tip of the central venous catheter lay in the region of the superior vena cava. An unenhanced brain CT scan performed o n a GE 8800 unit, employing a 1 cm collimator, reveaied multiple small, well-defined collections of markedly decreased attenuation within both cerebral hemispheres. Attenuation coefficients of the lesions were equivalent to that of air in the left frontal sinus. Presumably, the abnormalities represented intrahemispheric collections of air, probably within and around small-caliber arteries (Figure).Three hours later the patient was placed on 10056 oxygen and transferred to a monoplace hyperbaric recompression (HBR) chamber. One hundred percent oxygen given at 3 atm absolute pressure for 45 minutes elicited no improvement. H e was then transferred to a multiplace H B R chamber where the treatment protocol of the US Navy Diving Manual, Table GA, was followed [ 5 ] . N o improvement occurred, and the patient remained in a vegetative state until his death eight weeks later. CT scans performed four and six weeks postictus revealed poorly defined areas of infarction density scattered throughout both cerebral hemispheres. Investigation for the mechanism of paradoxical embolization by the indocyanine green test and the technetium 99m-labeled macroaggregated albumin test failed to show major right-to-left shunts in either the heart or lungs.Systemic air embolism is almost invariably iatrogenic ex-

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confidence: 99%

Confirmation of cerebral air embolism with computerized tomography

Hwang¹,

Fremaux²,

Sears³

et al. 1983

Annals of Neurology

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“…18 As in other models of acute occlusive ischemia, there was abundant swelling of astroglia accompanied by shrinkage and other structural changes in neurons.…”

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confidence: 75%

“…1 " Interestingly, hyperbaric oxygen can improve the energy state of brain tissue cmbolized with air and eliminates the mortality, which can reach 53% in the untreated rats. 18 Treatment with hyperbaric oxygen has been successfully applied in several instances of human arterial air embolism. 17 - 18> 19 Circulating gaseous bubbles may induce endothelial damage, which is not caused either by hypoxia or ischemia.…”

Section: Discussion-mentioning

confidence: 99%

Arterial air embolism: structural effects on the gerbil brain.

García¹,

Klatzo²,

Archer³

et al. 1981

Stroke

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CEREBRAL AIR EMBOLISM, both arterial and venous, acquires considerable significance because of the increase in either diagnostic or reparative cardiovascular procedures that require atmospheric exposure of the intravascular surfaces. Forty of 340 patients after open-heart surgery had signs of arterial embolism, and 34 of these had either psychologic or neurologic deficits attributable to brain air embolism. 1 In a separate study, the incidence of air embolism to the brain following open-heart surgery was estimated at 6 percent.2 Recent, comprehensive reviews of the English medical literature report the rate of complications of percutaneous subclavian catheterization ranging from 0.4 to 9.9 percent. 8Several reports of air embolism as an important complication of venous catheterizations have been published. 4 Venous air embolism to the brain, during posterior fossa craniotomy, occurs at a rate that ranges from 2.6 to 40 percent. 8 Air embolism is also a significant contributor to the number of deaths or illnesses resulting from rapid decompression. Seizures, focal neurologic deficits, unconsciousness and other symptoms in healthy divers have been attributed to air embolism into either the carotid-vertebral or coronary arteries. 8 -7 These deaths and symptoms could be the consequence of either cardiac or cerebral ischemia which, presumably, is induced by the transient mechanical occlusion of blood vessels by the air bubbles. 7The present study was undertaken to a) define some of the ultrastructural brain changes induced by carotid air embolism, and b) compare in the same species, the changes secondary to air embolism with those resulting from ischemia induced by carotid-artery ligation.

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“…22 Its benefits are increased if instituted within six hours after the occurrence of a VAE, but success associated with delayed administration has also been reported. 23 Administration of repetitive HOT is recommended until no further improvement is observed.…”

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confidence: 99%