Massive Arterial Air Embolism Due to Rupture of Pulsatile Assist Device: Successful Treatment in the Hyperbaric Chamber

Tomatis, L.; Nemiroff, Martin J.; Riahi, M.; Visser, Jantien; Visser, Eric; Davies, Annette; Helentjaris, D.; Stockinger, Fred S.; Kanten, Dick; Oosterheert, M.; Valk, A. DeTalma; Blietz, D.

doi:10.1016/s0003-4975(10)61806-1

Cited by 22 publications

(3 citation statements)

References 4 publications

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“…Our case series reinforces the suggestion 25,28 that, as with other high risk procedures, postcardiac surgical patients who are slow to regain consciousness and have evidence of focal neurological signs in the absence of other known potential causes, should be considered as having a diagnosis of CAGE.…”

Section: Iatrogenic Cage Its Diagnosis and The Role Of Neuroimagingsupporting

confidence: 85%

Hyperbaric Oxygen Therapy in the Treatment of Post Cardiac Surgical Strokes – a Case Series and Review of the Literature

Gibson

Davis

2010

Anaesth Intensive Care

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Strokes remain an uncommon but significant complication of cardiac surgery. Cerebral air embolism is the likely aetiology in the majority of cases. Hyperbaric oxygen therapy is the recognised treatment for cerebral air embolism associated with compressed air (SCUBA) diving accidents and is therefore also the standard of care for iatrogenic causes of air embolism. It follows that there is a logic in treating post-cardiac surgical stroke patients with hyperbaric oxygen. The aim of this retrospective review was to examine the outcomes of 12 such patients treated in the Christchurch Hospital hyperbaric unit and to appraise the evidence base for the use of hyperbaric oxygen therapy in this setting. Despite delays of up to 48 hours following surgery before the institution of hyperbaric oxygen therapy, 10 of the 12 patients made a full neurological recovery or were left with mild residual symptoms, with nine returning to their previous level of care. One patient remained hemiplegic and there was one early neurological death. There is a paucity of prospective data in this area, but based on sound pathophysiological principles and clinical experience, we believe that patients suffering a stroke following open cardiac surgery should be considered for hyperbaric oxygen therapy.

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Section: Iatrogenic Cage Its Diagnosis and The Role Of Neuroimagingsupporting

confidence: 85%

Hyperbaric Oxygen Therapy in the Treatment of Post Cardiac Surgical Strokes – a Case Series and Review of the Literature

Gibson

Davis

2010

Anaesth Intensive Care

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“…Research shows that the results of cerebral imaging by CT or MRI in a patient presenting with a neurological deficit after cardiac surgery are often nonspecific and do not allow the definitive diagnosis or exclusion of cerebral arterial gas emboli, and thus should not extend the delay for initiating HOT [2, 4, 25, 26]. …”

Section: Discussion and Literature Reviewmentioning

confidence: 99%

Delayed hyperbaric oxygen therapy for air emboli after open heart surgery: case report and review of a success story

Niyibizi

Kembi

Lae

et al. 2016

J Cardiothorac Surg

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BackgroundThe current case describes a rare diagnosis of iatrogenic air emboli after elective cardiopulmonary bypass that was successfully treated with delayed hyperbaric oxygen therapy, with good clinical evolution in spite of rare complications.Case presentationA 35 years old male was admitted to the intensive care unit (ICU) for post-operative management after being placed on cardiopulmonary bypass (CPB) for an elective ventricular septal defect closure and aortic valvuloplasty. The patient initially presented with pathologically late awakening and was extubated 17 h after admission. Neurologic clinical status after extubation showed global aphasia, mental slowness and spatio-temporal disorientation. The injected cerebral CT scan was normal; the EEG was inconclusive (it showed metabolic encephalopathy without epileptic activity); and the cerebral MRI done 48 h after surgery showed multiple small subcortical acute ischemic lesions, mainly on the left fronto- parieto- temporo-occipital lobes. He was taken for hyperbaric oxygen therapy (HOT) over 54 h after cardiac surgery. The first session ended abruptly after 20 min when the patient suffered a generalised tonico-clonic seizure, necessitating a moderately rapid decompression, airway management, and antiepileptic treatment. In total, the patient received 7 HOT sessions over 6 days. He demonstrated full neurological recovery at 4 weeks and GOS (Glasgow Outcome Scale) of 5 out of 5 even after a long delay in initial management. Convulsions are a rare complication of HOT either due to reperfusion syndrome or hyperoxic toxicity and can be managed. Prior imaging by MRI or tympanic paracentesis (myringotomy) should not add further delay of treatment.ConclusionHOT should be initiated upon late awakening and/or neurologic symptoms after CPB heart surgery, after exclusion of formal counter-indications, even if the delay exceeds 48 h.

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“…Massive arterial air embolism has been reported secondary to rupture of the balloon catheter. This has been treated with decompression in a hyperbaric chamber [111].…”

Section: Intraaortic Balloonmentioning

confidence: 99%

Iatrogenic Cardiovascular Disease Secondary to Diagnostic and Therapeutic Procedures

Gold

Rios²

1987

J Intensive Care Med

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Gold RL, Rios JC. latrogenic cardiovascular disease secondary to diagnostic and therapeutic procedures. J Intensive Care Med 1987;2:49-60.The number of diagnostic and therapeutic procedures performed in cardiology continues to grow. These procedures are generally considered safe or of minimal risk to the patient. However, it is important to remember that significant complications may occur, and in each patient the risk: benefit ratio must be carefully weighed.In this review, the complications documented in the medical literature resulting from the use of cardiologic interventions and procedures are discussed. A thorough knowledge of these complications and their precipitating factors can help minimize the risk to the patient.

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Massive Arterial Air Embolism Due to Rupture of Pulsatile Assist Device: Successful Treatment in the Hyperbaric Chamber

Cited by 22 publications

References 4 publications

Hyperbaric Oxygen Therapy in the Treatment of Post Cardiac Surgical Strokes – a Case Series and Review of the Literature

Hyperbaric Oxygen Therapy in the Treatment of Post Cardiac Surgical Strokes – a Case Series and Review of the Literature

Delayed hyperbaric oxygen therapy for air emboli after open heart surgery: case report and review of a success story

Iatrogenic Cardiovascular Disease Secondary to Diagnostic and Therapeutic Procedures

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