Infant Death Due to Air Embolism from Peripheral Venous Infusion

Abstract

An otherwise healthy male infant was brought to the hospital because the mother suspected superficial infection at the operative site 5 days after an inguinal hernia repair. He was admitted to the pediatric unit overnight to be evaluated by his surgeon the next morning. When a venous infusion of maintenance fluids was started, the patient immediately went into cardio-respiratory arrest and was pronounced dead after resuscitation efforts failed. Subsequently, air collections were found in both venous and arterial circulations, including the splenoportal system. Detailed review of the clinical presentation and course, laboratory results, radiological, and pathological findings, along with a review of pertinent literature provides an explanation for the death by air embolism. Apparent inconsistent findings both radiographically and at autopsy are resolved. The mechanism of distribution of air to both systemic and splenoportal circulation is discussed. We believe this to be only the eighth case reported in English-language literature of infantile death from peripheral venous infusion. In all age groups, we find only six other cases in the English-language literature of gas found concomitantly in both the systemic and portal venous systems.

Nonthrombotic pulmonary embolism

“…It has been occasionally reported when a peripheral venous infusion was started [252] or after contrast-enhanced CT examination [253]. The incidences during diagnostic cardiac catheterisation and percutaneous coronary intervention are 0.84% and 0.24%, respectively [254].…”

Air Embolism in the Newborn: Rare Complication of Intensive Care Therapy in Children

“…3,5,8,9 In the preultrasound era, air in the fetal circulation was described as a sign of intrauterine fetal demise, appearing within 3 days of the estimated time of death. 31 Clinical signs of SAE are sudden and dramatic 19,20,23 : cardiovascular collapse, sudden deterioration in respiratory status, pallor, cyanosis, irregularities in cardiac rhythm, as well as seizures and/or the development of neurological defects in non-fatal central nervous system emboli. 18 One hundred percent oxygen has been shown to increase the reabsorption of extra-alveolar air and to increase the oxygen concentration in the areas distal to the emboli, thus reducing the chance of hypoxic damage.…”

“…Both SAE and pulmonary vein air embolism are rare, [1][2][3][4][5][7][8][9][10][11][12][13][18][19][20][21][22][23] and there are only a few reported patients who have survived these usually fatal complications. 4,5,18 In the surviving case reported by Kogutt, the patient had no clinical symptoms and the diagnosis was based on radiographic findings only, 4 and an infant with such a condition treated by Weiner et al survived 13 days.…”

Fatal Air Embolism During Renal Dialysis

“…Systemic venous air can enter the systemic arterial system in the lungs via arteriovenous malformations or, if pressures are high enough, through precapillary arteriovenous anastomoses. 1 In addition, precapillary arterial venous anastomoses have been described in many organs including the liver, brain, and spleen. 2Y4 A shunt is not even necessary for venous air embolism to cause intracranial arterial embolism; air bubbles can rise against thoracocervical venous flow depending on factors of cardiac output, central vein diameter, and bubble size.…”