Does Venous Air Embolism Occur During Air/Fluid Exchange?

El-Annan, Jaafar

doi:10.1001/archophthalmol.2011.237

Cited by 3 publications

(10 citation statements)

References 4 publications

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“…Air under continuous pressure might then enter the systemic venous circulation through torn vortex vein ampullae1 2 3 (figure 1), at a rate sufficient to quickly block pumping action of the heart,4 or to cause fatal emboli into the arterial circulation through a patent foramen ovale 2. In fact, using 40 mm Hg infusion pressure through a 25-gauge line, we measured air flow against atmospheric pressure to be approximately 350 ml per minute.…”

Section: Discussionmentioning

confidence: 99%

“…Should this occur, inadvertent liquid infusion is curable by external drainage, or it may resolve spontaneously. However, if air infused suprachoroidally can cause potentially fatal VAE, we must respond decisively with new safety precautions 1––3…”

Section: Discussionmentioning

confidence: 99%

“…Even for those who have, scepticism that a fatal dose of suprachoroidal air could rapidly pass through the eye into the heart is understandable 3. The OAFE/VAE connection has only recently and rarely been reported, and VAE is typically a transitory, clinical diagnosis.…”

Section: Prevention Of Vaementioning

confidence: 99%

“…For example, the three reported eye cases took years to enter the ophthalmology literature, finally appearing only because an uninvolved ophthalmologist accidentally happened upon them while reading the anaesthesia literature for other reasons 2 3. These factors do not support OAFE/VAE scepticism.…”

Section: Prevention Of Vaementioning

confidence: 99%

“…Lim's article was met by only one letter of comment that characterised the OAFE connection to VAE as still unproven despite the reported cases 3. The aims of our article are to provide additional evidence that inadvertent suprachoroidal air infusion could tear vortex veins and rapidly entrain air into the systemic circulation, as described by Ledowski and Lim1 2 (figure 1); to show that such an occurrence may be more likely, as vitrectomy has increasingly moved to 25-guage and 23-gauge unsutured infusion cannulas; and to point out that, once acknowledged, the risk of fatal VAE during OAFE can be almost eliminated by simple procedural precautions.…”

Section: Introductionmentioning

confidence: 99%

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Presumed Air by Vitrectomy Embolisation (PAVE) a potentially fatal syndrome

et al. 2013

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BackgroundSince first being reported in the ophthalmology literature in 2010, three cases (one fatal) of suspected venous air embolism (VAE) during vitrectomy have received little notice, and the vitrectomy/VAE connection has been described as unproven. We investigated the ability of air to exit the eye through vortex veins after accidental suprachoroidal air infusion.MethodsVitrectomy was performed on four donor eyes. Unsutured cannulas were partially withdrawn during air fluid exchange, producing choroidal detachments that emulated accidental suprachoroidal air infusion from a slipping cannula. Eyes with and without clamping of the vortex vein stumps were partially submerged in a water bath.ResultsExtensive choroidal detachment was created in all eyes during air infusion. All eyes with open vortex veins demonstrated rapid air extravasation/bubbling. An eye with clamped vortex vein stumps showed no air extravasation until the clamps were removed.ConclusionsWhen combined with existing clinical reports of suspected VAE in the eyes of living patients during ocular air fluid exchange, this experiment justifies recognition of presumed air by vitrectomy embolisation (PAVE) as a rare but potentially fatal vitrectomy complication. Simple surgical precautions can change PAVE from a ‘rare event’ to a ‘never event’, beginning with acknowledgment of its existence.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Prevention Of Vaementioning

confidence: 99%

Section: Prevention Of Vaementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Presumed Air by Vitrectomy Embolisation (PAVE) a potentially fatal syndrome

et al. 2013

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Venous Air Embolism During Pars Plana Vitrectomy: A Case Report and Review of the Literature

Kasi

Grant

Flynn

et al. 2017

Journal of VitreoRetinal Diseases

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Presumed venous air embolism (PVAE) is a rare and potentially fatal complication of pars plana vitrectomy that is poorly described and understood but requires improved awareness among ophthalmologists and vitreoretinal surgeons. Methods: A case report is presented along with a systematic review of published reports of PVAE during ocular surgery. Results: An otherwise healthy adult male undergoing retinal detachment repair under local anesthesia with monitored anesthesia care died from a PVAE. Literature search yielded 2 experimental models, 6 individual case reports, and several editorials. Review of existing reports reveals that PVAE can affect patients of any age or gender with no medical predilection and occurs in cases of trauma, endoresection, or retinal detachment repair. It is typically associated with a drop in end-tidal carbon dioxide during fluidair exchange and can present similar to a hemorrhagic choroidal detachment. Analysis suggests that venous air embolism can be prevented by ensuring full engagement of the infusion cannula into the vitreous cavity prior to fluid-air exchange. Conclusion: Presumed venous air embolism is a potentially fatal complication of ocular surgery and in some cases may be recognized by ophthalmologists as a choroidal detachment during fluid-air exchange in pars plana vitrectomy. It is imperative to immediately stop the air infusion line if venous air embolism is suspected.

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Ocular Venous Air Embolism (OVAE): A Review

Morris

Boyd²,

Sapp

et al. 2019

Journal of VitreoRetinal Diseases

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Purpose: The purpose of this article is to review and analyze reported cases of ocular venous air embolism (OVAE) to develop a reliable clinical definition of OVAE and effective prevention strategies. Methods: We reviewed all reports of suspected air embolism during vitrectomy published in PubMed since the introduction of pars plana vitrectomy, and 5 cases found elsewhere and separately reported concurrent with this review. Results: OVAE is a precipitous drop in end-tidal CO2, a choroidal detachment, or a choroidal wound, followed by signs of impending or actual cardiovascular collapse, during vitrectomy air infusion. In each case meeting the above clinical definition, entrained air was found whenever it was sought (8/8, 100%), either by antemortem imaging or postmortem forensic investigations. Most OVAE cases were fatal (9/13, 69%), with 8 of 9 deaths (89%) occurring the day of surgery. Conclusions: OVEA is a rare but usually fatal complication of air infusion into the eye during vitrectomy. Although received with skepticism when first reported (2005), OVAE may be the most lethal type of surgical air embolization because of its high entrainment pressure and proximity to the heart. Because the effective response time to avoid a fatal OVAE outcome can be less than 1 minute, use of preventive measures is critical—most notably a “time out” before air infusion to confirm infusion cannula positioning, and immediate cessation of air infusion if choroidal detachment is detected.

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Does Venous Air Embolism Occur During Air/Fluid Exchange?

Cited by 3 publications

References 4 publications

Presumed Air by Vitrectomy Embolisation (PAVE) a potentially fatal syndrome

Presumed Air by Vitrectomy Embolisation (PAVE) a potentially fatal syndrome

Venous Air Embolism During Pars Plana Vitrectomy: A Case Report and Review of the Literature

Ocular Venous Air Embolism (OVAE): A Review

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