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DOI:10.2214/AJR.06.5595
AJR 2007; 188:W98
© American Roentgen Ray Society

Hyperbaric Oxygen Therapy for Arterial Air Embolism

Zubin N. Balsara and Deland D. Burks

St. Edward Mercy Medical Center Fort Smith, AR 72917



 
WEB—This is a Web exclusive article.

In the case conference on percutaneous lung biopsy [1], Maher and colleagues discussed the treatment of arterial air embolism. Their management included administration of 100% oxygen and placement of the patient in the left lateral position to confine the air to the right heart. The positioning of a patient in the left lateral decubitus with the head down (Trendelenberg's) position is generally accepted as treatment for venous air embolism, not for arterial air embolism [2]. The air embolism of concern in percutaneous lung biopsy is of the arterial type. The authors also failed to mention the use of hyperbaric oxygen therapy. Although not part of immediate resuscitation, expeditious use of hyperbaric oxygen therapy is presently the treatment of choice for arterial air embolism.

Arterial air embolism can have fatal consequences, particularly when air embolizes to the coronary or cerebral circulation. This condition is more commonly encountered in cardiac operations with the use of cardiopulmonary bypass. Hyperbaric oxygen therapy is the accepted mode of treatment for arterial air embolization related to cardiac surgery [3]. Hyperbaric oxygen therapy is also the specific therapy for patients with arterial air embolism who are undergoing percutaneous lung biopsy. Illustrating this point, in one series, study four of five patients suffering from air embolism after percutaneous lung biopsy who received hyperbaric oxygen therapy recovered, but four of seven patients who received no hyperbaric therapy died [4].

Initial treatment of arterial air embolization includes maximal oxygenation, addressing the patient's hemodynamic status and cardiovascular compromise. Oxygenation can be provided with a tight-fitting mask or intubation. If the patient is somnolent or unresponsive, intubation allows airway control, ventilation, and application of 100% oxygen. Cerebral hypoxia or anoxia can lead to seizures that may not respond to benzodiazepines. The use of steroids and positioning the patient in a steep Trendelenberg's and right lateral decubitus are controversial but recommended by many [4]. After stabilizing the patient, immediate transport to a hyperbaric oxygen chamber should be arranged. (Note: Subsequent to submission of this letter to the editor, a new case report has been published on this topic [5].)


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 References
 

  1. Maher MM, Kalra MK, Titton RL, et al. Percutaneous lung biopsy in a patient with a cavitating lung mass: indications, technique, and complications. AJR2005; 185:989 -994[Free Full Text]
  2. Coulter TD, Wiedemann HP. Gas embolism. (comment on Muth and Shank) N Engl J Med2000; 342:2000 -2002[Free Full Text]
  3. Ziser A, Adir Y, Lavon H, Shupak A. Hyperbaric oxygen therapy for massive arterial air embolism during cardiac operations. J Thoracic Cardiovasc Surg 1999;117:818 -821[Abstract/Free Full Text]
  4. Ashizawa K, Watanabe H, Morooka H, Hayashi K. Hyperbaric oxygen therapy for air embolism complicating CT-guided needle biopsy of the lung. AJR 2004;182:1606 -1607[Free Full Text]
  5. Lattin G Jr, O'Brien W Sr, McCrary M, et al. Massive air embolism treated with hyperbaric oxygen therapy following CT-guided transthoracic needle biopsy of a pulmonary nodule. J Vasc Interv Radiol 2006;17:1355 -1358[CrossRef][Medline]

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This Article
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