Air embolism medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Air embolism is a medical emergency and should be treated immediately.

Medical Therapy

The mainstay of therapy for air embolism is high flow oxygen therapy with 100% oxygen.

During surgery:

  • Cover surgical site
    • This prevents further air trapping[1]
  • Tilt operating table
    • This lowers the source of air entry and eliminates negative air pressure gradient[2]
  • Reverse Trendelenburg in procedures that are lower than the heart[3]
  • Jugular venous compression during cranial or facial surgery
    • This decreases distal venous pressure and eliminates further air entry from face and head[4]

Post Surgery:

  • High flow oxygen therapy/Hyperbaric oxygen therapy
    • This increases partial pressure of nitrogen and oxygen in blood leading to decrease in size of bubble and acceleration of bubble resorption[5]
  • Aspiration of air from right atrium
    • Using the Bunegin Albin catheter[6]
    • Swan Ganz catheter is shown to be ineffective[7]
  • Hemodynamic and Cardiopulmonary resuscitation if necessary
    • Some studies have shown cardiac massage may be beneficial
      • This forces air out of pulmonary outflow tract leading to improved lateral blood flow[8]

References

  1. Marek A. Mirski, Abhijit Vijay Lele, Lunei Fitzsimmons & Thomas J. K. Toung (2007). "Diagnosis and treatment of vascular air embolism". Anesthesiology. 106 (1): 164–177. PMID 17197859. Unknown parameter |month= ignored (help)
  2. Marek A. Mirski, Abhijit Vijay Lele, Lunei Fitzsimmons & Thomas J. K. Toung (2007). "Diagnosis and treatment of vascular air embolism". Anesthesiology. 106 (1): 164–177. PMID 17197859. Unknown parameter |month= ignored (help)
  3. Marek A. Mirski, Abhijit Vijay Lele, Lunei Fitzsimmons & Thomas J. K. Toung (2007). "Diagnosis and treatment of vascular air embolism". Anesthesiology. 106 (1): 164–177. PMID 17197859. Unknown parameter |month= ignored (help)
  4. T. Takahashi, K. Yano, T. Kimura, T. Komatsu & Y. Shimada (1997). "Prevention of venous air embolism by jugular venous compression under superior sagittal sinus pressure monitoring in a brachycephalic patient during craniofacial reconstruction". Paediatric anaesthesia. 7 (3): 259–260. PMID 9189976.
  5. Marek A. Mirski, Abhijit Vijay Lele, Lunei Fitzsimmons & Thomas J. K. Toung (2007). "Diagnosis and treatment of vascular air embolism". Anesthesiology. 106 (1): 164–177. PMID 17197859. Unknown parameter |month= ignored (help)
  6. P. S. Colley & A. A. Artru (1989). "Bunegin-Albin catheter improves air retrieval and resuscitation from lethal venous air embolism in upright dogs". Anesthesia and analgesia. 68 (3): 298–301. PMID 2919770. Unknown parameter |month= ignored (help)
  7. R. F. Bedford, W. K. Marshall, A. Butler & J. E. Welsh (1981). "Cardiac catheters for diagnosis and treatment of venous air embolism: a prospective study in man". Journal of neurosurgery. 55 (4): 610–614. doi:10.3171/jns.1981.55.4.0610. PMID 6792326. Unknown parameter |month= ignored (help)
  8. J. A. ERICSSON, J. D. GOTTLIEB & R. B. SWEET (1964). "CLOSED-CHEST CARDIAC MASSAGE IN THE TREATMENT OF VENOUS AIR EMBOLISM". The New England journal of medicine. 270: 1353–1354. doi:10.1056/NEJM196406182702507. PMID 14140269. Unknown parameter |month= ignored (help)



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