Transesophageal echocardiography detection of air embolism during endoscopic surgery and validity of hyperbaric oxygen therapy

Abstract

Introduction: Air embolism has the potential to be serious and fatal. In this paper, we report 3 cases of air embolism associated with endoscopic medical procedures in which the patients were treated with hyperbaric oxygen immediately after diagnosis by transesophageal echocardiography. In addition, we systematically review the risk factors for air embolism, clinical presentation, treatment, and the importance of early hyperbaric oxygen therapy efficacy after recognition of air embolism. Patient Concerns: We present 3 patients with varying degrees of air embolism during endoscopic procedures, one of which was fatal, with large amounts of gas visible in the right and left heart chambers and pulmonary artery, 1 showing right heart enlargement with increased pulmonary artery pressure and tricuspid regurgitation, and 1 showing only a small amount of gas images in the heart chambers. Diagnoses: Based on E T CO 2 and transesophageal echocardiography (TEE), diagnoses of air embolism were made. Interventions: The patients received symptomatic supportive therapy including CPR, 100% O 2 ventilation, cerebral protection, hyperbaric oxygen therapy and rehabilitation. Outcomes: Air embolism can causes respiratory, circulatory and neurological dysfunction. After aggressive treatment, one of the 3 patients died, 1 had permanent visual impairment, and 1 recovered completely without comorbidities. Conclusions: While it is common for small amounts of air/air bubbles to enter the circulatory system during endoscopic procedures, life-threatening air embolism is rare. Air embolism can lead to serious consequences, including respiratory, circulatory, and neurological impairment. Therefore, early recognition of severe air embolism and prompt hyperbaric oxygen therapy are essential to avoid its serious complications.

Air Embolism Developed as a Result of Opening the Central Catheter Tip by the Patient's Relative

“…9 The "gold standard" for the detection of venous air embolism is the trans-oesophageal echocardiography (TEE) due to its ability to detect as little as 0.02 mL/kg of air; however, the cost, expertise, and resource requirements limit its utility as a standard screening tool. 10 In our patient, TEE could not be performed due to technical reasons, and air could not be seen in TEE.…”

Chest x-ray feature of venous air embolism in orthopedic surgery in prone position: A case report

“…Furthermore, fatal VAEs occur very rarely and are poorly understood by orthopedic surgeons. In addition, a fatal VAE can cause chest pain, cyanosis, dyspnea, a drop in blood pressure, increased pulmonary artery pressure, cardiac arrest, and other clinical features ( 7 , 10 , 12 , 13 ). These symptoms are similar to those of a pulmonary embolism caused by deep vein thrombosis, which was confused by orthopedic surgeons.…”

“…A VAE during orthopedic surgery is often misdiagnosed as thrombosis. Therefore, when a fatal VAE occurs, it is important to obtain a clear diagnosis early and quickly to save the patient's life ( 13 ). To quickly diagnose a pulmonary embolism caused by a VAE, it is necessary to enhance the orthopedic surgeon’s knowledge of VAE and recognize that some surgical positions, including the sitting, prone, and lateral positions, may lead to the risk of a VAE.…”

PICC entrapment and air embolism on veno-venous extracorporeal membrane oxygenation: A case report

“…When in close proximity, we recommend at least intermittent monitoring of the position of the tip of the CVC with chest X-ray imaging and that it be kept in mind as a potential source of air entrainment. Transesophageal echocardiography has also been shown to be an extremely valuable tool in detecting air embolisms, 13,14 and can be utilized to determine optimal positioning of guidewire and CICCs/PICCs placement. 15 Use of magnetic or intracavitary electrocardiogram guided catheter placement can also help avoid mispositioning of these catheters at the time of placement.…”