Arterial Gas Embolism

Basics

Description

  • Occurs when air bubbles enter the arterial system and propagate throughout the systemic vasculature:
    • Clinical manifestations depend on location of air bubbles in systemic vasculature
  • Can be due to introduction of air into arterial system iatrogenically, or to pulmonary over-pressurization, causing pleural tear, resulting in air entering the vascular circulation:
    • Trapped air (in lungs with closed glottis) expands on diver ascent
    • Boyle’s law: At a constant temperature, pressure (P) is inversely related to volume (V):
      • PV = K (constant) or P1V1 = P2V2
    • As pressure decreases, volume increases

Etiology

  • Pulmonary atrioventricular (AV) shunts
  • Preexisting intracardiac right-to-left shunt: paradoxical embolism via a patent foramen ovale (PFO) or atrial septal defect (ASD)
  • Diving and decompression injury: Breath-holding during ascent, rapid ascent
  • Iatrogenic during placement of central venous pressure (CVP) lines and during hemodialysis
  • Surgical procedures:
    • Cardiothoracic: Cardiopulmonary bypass grafting, angioplasty, IR procedures requiring intravascular sheaths
    • Pulmonary: Lung biopsy
    • Neurosurgical: Sitting craniotomy, spinal fusion, or cervical laminectomy
    • Laparoscopic procedures
  • Penetrating chest trauma

There's more to see -- the rest of this topic is available only to subscribers.