• arterial gas embolism
• hyperbaric oxygen therapy
• mitral transcatheter edge‐to‐edge repair

• The authors received no specific funding for this work.

• air embolism
• cardiac arrest
• left ventricular air embolism
• pulmonary disease
• transthoracic guided lung biopsy

• Humans
• Embolism, Air/prevention & control
• Embolism, Air/etiology
• Health Knowledge, Attitudes, Practice
• Catheterization, Central Venous/adverse effects
• Catheterization, Central Venous/instrumentation
• Device Removal
• Central Venous Catheters/adverse effects
• Surveys and Questionnaires
• Clinical Competence/statistics & numerical data
• Female
• Nursing Staff, Hospital
• Male
• Medical Staff, Hospital

• case report
• cerebral air embolism
• hyperbaric oxygen therapy
• long-term hemodialysis catheter
• lung transplant

• cardiovascular implantable electronic devices
• hyperbaric oxygen treatment

• Humans
• Embolism, Air/etiology
• Fatal Outcome
• Male
• Esophagoscopy
• Intracranial Embolism/etiology
• Intracranial Embolism/diagnostic imaging
• Dilatation

• air embolism
• cerebral embolism
• cerebral stroke
• hyperbaric oxygen therapy
• neurological emergency

• Ministry of Health of the Czech Republic
• Charles University

• Embolism, Air
• Microvessels/diagnostic imaging
• Humans
• Microfluidic Analytical Techniques/instrumentation
• Lab-On-A-Chip Devices

• Computed Tomography Perfusion
• Embolic Stroke
• Gas Embolism
• Iatrogenic Disease

• Humans
• Retrospective Studies
• Tomography, X-Ray Computed/methods
• Embolism, Air/diagnostic imaging
• Cohort Studies
• Perfusion
• Iatrogenic Disease
• Perfusion Imaging/methods
• Cerebrovascular Circulation/physiology
• Stroke
• Brain Ischemia

• CT
• Cerebral air embolism
• Emergency radiology
• Endovascular procedures
• Gyriform air
• Hyperbaric oxygen therapy

• Humans
• Embolism, Air/diagnostic imaging
• Embolism, Air/etiology
• Embolism, Air/therapy
• Tomography, X-Ray Computed

• air embolism
• arterioles
• decompression sickness
• hyperbaric oxygenation
• microbubbles
• thromboinflammation

• Humans
• Embolism, Air/diagnosis
• Embolism, Air/etiology
• Embolism, Air/therapy
• Thromboinflammation
• Inflammation/therapy
• Inflammation/complications
• Thrombosis/complications
• Iatrogenic Disease

• Air
• CT
• Embolism
• Prognosis
• Stroke
• Thrombectomy

• Humans
• Stroke/diagnostic imaging
• Stroke/surgery
• Brain Ischemia/diagnostic imaging
• Brain Ischemia/surgery
• Prospective Studies
• Thrombectomy/methods
• Treatment Outcome
• Endovascular Procedures/methods
• Ischemic Stroke
• Middle Cerebral Artery/diagnostic imaging
• Tomography, X-Ray Computed

• Air embolism
• Embolic stroke
• Hyperbaric oxygenation
• Iatrogenic disease

• cerebral air embolism
• coma
• dental procedure
• hyperbaric oxygen therapy
• super-refractory status epilepticus

• case report
• incidental finding
• saudi arabia.
• transient cerebral ischemia
• venous air embolism

• air embolism
• atrial septal defect
• autologous blood transfusion
• case report

Air embolisms are mostly iatrogenic and a rare yet dreaded complication following percutaneous procedures. Intravascular entrapment of air can result in occlusion of end arteries and subsequent tissue ischemia and infarction. Cerebrovascular occlusions caused by air embolisms are time-sensitive and an uncommon cause of ischemic stroke, warranting an alternative acute management and reperfusion strategy.

During a CT-guided lung biopsy, the patient developed left-sided paresis and sensory deficits prior to loss of consciousness. CT revealed air in the aorta, both ophthalmic arteries and vessels in the right parietal region. The patient was swiftly air-lifted to the nearest hyperbaric oxygen chamber for an alternate emergency reperfusion therapy. The following eight days the patient received hyperbaric oxygen therapy and gradually improved. Nine days after symptom onset he was discharged with a minor left facial palsy.

Cerebrovascular occlusions are critical events regardless of etiology. Air embolism is rare but potentially catastrophic and can occur during both percutaneous procedures and surgeries. Vigilance and knowledge of this potential complication are needed to rapidly provide beneficial treatment. That is, high flow oxygen and correct positioning pending hyperbaric oxygen therapy.

Air embolism is a very rare, yet serious and potentially fatal complication of digestive endoscopic treatment. Air embolism is the result of air directly entering the arteries or veins. However, to recognize neurological dysfunction under sedation can be difficult. Therefore, it is extremely important to identify high-risk groups and take preventive measures.

Herein, we report a 74-year-old female patient with esophageal varices who suffered from consciousness disturbance after the third endoscopic ligation of esophageal varices under sedation. Combined with the patient’s imaging examination results and medical history, we highly suspected that the patient had developed paradoxical cerebral air embolism during endoscopic ligation. We learned that the patient died at a later follow-up. In order to be able to identify and prevent the occurrence of air embolism early, we summarize and analyze the risk factors, pathogenesis, clinical manifestations, prevention and treatment options of gastrointestinal endoscopy complicated by cerebral air embolism.

Electroencephalographic monitoring helps to recognize the occurrence of air embolism in time and increase the patient's chance of survival.

• Cerebral infarction
• Paradoxical air embolism
• Endoscopic ligation
• Esophageal variceal
• Sedation
• Case report

Cerebral air embolism is a rare, yet serious neurological occurrence with unclear incidence and prevalence. Here, we present a case of fatal cerebral arterial and venous cerebral gas embolism in a patient with infective endocarditis and known large right-to-left shunt and severe tricuspid regurgitation following pressurized fluid bolus administration. Case Presentation. A 32-year-old female was admitted to the medical intensive care unit from a long-term acute care facility with acute on chronic respiratory failure. Her medical history was significant for intravenous heroin and cocaine abuse, methicillin-sensitive Staphylococcus aureus tricuspid valve infective endocarditis on vancomycin, patent foramen ovale, septic pulmonary embolism with cavitation, tracheostomy with chronic ventilator dependence, multifocal cerebral infarction, hepatitis C, nephrolithiasis, anxiety, and depression. After intravenous fluid administration, she became unresponsive with roving gaze, sluggish pupils, and hypotensive requiring vasopressors. CT of the brain showed diffuse arterial and venous cerebral air embolism secondary to accidental air administration from fluid bolus. Magnetic resonance imaging of the brain showed diffuse global anoxic injury and flattening of the globe at the optic nerve insertion. Given poor prognosis, her family chose comfort measures and she died.

Fatal cerebral air embolism can occur through peripheral intravenous routes when the lines are inadequately primed and fluids administered with pressure. Caution must be exercised in patients with right-to-left shunting as air may gain access to systemic circulation.

Supplemental Digital Content is available in the text.

Iatrogenic cerebral arterial gas embolism occurs when gas enters the cerebral arterial circulation during a medical procedure and is considered a severe complication. Seizures have been described in these patients, but information on clinical characteristics, treatment, and outcome is lacking in current literature. The aim of the study was to explore seizures in patients with iatrogenic cerebral arterial gas embolism and to evaluate management strategies.

Retrospective single-center observational study.

The only university hospital in the Netherlands with a hyperbaric oxygen therapy facility.

All patients presenting at or referred to our center with iatrogenic cerebral arterial gas embolism between May 2016 and December 2020.

Not applicable.

Fifteen patients with iatrogenic cerebral arterial gas embolism were identified, of whom 11 (73%) developed seizures. Five patients developed their first seizure prior to hyperbaric oxygen therapy, three during hyperbaric oxygen therapy, and three after hyperbaric oxygen therapy. Of the 11 patients with seizures, all but one were treated with anti-epileptic drugs. With a median follow-up time of 5 months (range, 1–54 mo), five patients showed complete neurologic recovery, five had minor neurologic deficit, two had moderate to severe neurologic deficit, and three had died. Four patients still used anti-epileptic drugs at follow-up. No patients had recurrent seizures after hospital discharge.

`Seizures are a common symptom in iatrogenic cerebral arterial gas embolism. They are often treated with anti-epileptic drugs and do not seem to lead to chronic epilepsy.

• air embolism
• brain ischemia
• epilepsy
• hyperbaric oxygenation
• seizures
• stroke

• clinical issues
• radiation injury
• radiotherapy
• regenerative medicine

• air embolism
• case report
• hyperbaric oxygen
• transesophageal echocardiography

• Adult
• Early Medical Intervention/methods
• Echocardiography, Transesophageal/methods
• Embolism, Air/diagnosis
• Embolism, Air/etiology
• Embolism, Air/physiopathology
• Embolism, Air/therapy
• Endoscopy/adverse effects
• Endoscopy/methods
• Female
• Heart/diagnostic imaging
• Humans
• Hyperbaric Oxygenation/methods
• Male
• Middle Aged
• Patient Care Management/methods
• Pulmonary Artery/diagnostic imaging
• Risk Assessment
• Risk Factors
• Severity of Illness Index
• Treatment Outcome

• brain injury
• decrees
• recompression
• spinal injury
• treatment

• cancer intervention
• lung cancer (oncology)
• radiology (diagnostics)

An air embolism (AE) is a rare but dreaded complication during endovascular procedures. Current guidance recommends hyperbaric oxygen therapy and aspiration for the management of a venous AE. However, the management of an arterial AE is much less described. We report a case of a 79-year-old man with symptomatic mitral regurgitation who underwent a MitraClip procedure. During the intervention, a massive AE was detected in the ascending aorta on transesophageal echocardiography. The AE was successfully aspirated while the patient remained hemodynamically stable. This report demonstrates the efficacy of an arterial AE’s aspiration with a real-time echocardiography recording of the technique.

• arterial gas embolism
• breath‐hold diving
• cerebral stroke
• decompression illness
• magnetic resonance imaging

• convulsive syndrome
• paradoxical air embolism
• posterior cranial fossa

• air embolism
• hyperbaric oxygen therapy
• stroke

Air embolism is a rare, but potentially catastrophic complication of endoscopic procedures. We herein evaluated the overall incidence of air embolism after endoscopy. We also measured mortality outcomes after air embolism.

Patients who underwent endoscopy as an index procedure during hospitalization were selected from the National Inpatient Sample from 1998-2013. The primary outcome of interest was the incidence of air embolism after endoscopy. All-cause mortality after endoscopy was measured as a secondary outcome and the Charlson Comorbidity Index was calculated. Binary logistic regression was used to explore the effect of air embolism on inpatient mortality, using P<0.05 as level of significance.

A total of 2,245,291 patients met the inclusion criteria. Mean age at the time of procedure was 62.5 years. Esophagogastroduodenoscopy (EGD) was the most common endoscopic procedure, accounting for 80% of endoscopic procedures. Air embolism occurred in 13 cases, giving a rate of 0.57 per 100,000 endoscopic procedures. Air embolism was most common after endoscopic retrograde cholangiopancreatography (ERCP), occurring in 3.32 per 100,000 procedures, compared with 0.44 and 0.38 per 100,000 procedures for EGD and colonoscopy, respectively. The case fatality rate for post endoscopic air embolism was 15.4%. After adjusting for covariates, air embolism after endoscopy was independently associated with higher odds of inpatient mortality: odds ratio 10.35, 95% confidence interval 1.21-88.03 (P<0.03).

Air embolism is most common after ERCP. It is frequently associated with disorders involving a breach to the gastrointestinal mucosa or vasculature. Though rare, it is an independent predictor of inpatient mortality.

• Air embolism
• endoscopy
• mortality

• Carbon dioxide
• Cholecystectomy
• Embolism
• Laparoscopy

• Carbon Dioxide/adverse effects
• Cholecystectomy, Laparoscopic/adverse effects
• Embolism, Air/diagnosis
• Embolism, Air/prevention & control
• Embolism, Air/surgery
• Humans
• Insufflation/adverse effects
• Risk Factors

• klebsiella pneumoniae
• liver abscess
• pneumocardia
• septic pulmonary embolism

• Aged
• Anti-Bacterial Agents/therapeutic use
• Drainage/methods
• Female
• Heart/diagnostic imaging
• Humans
• Klebsiella Infections/complications
• Klebsiella Infections/drug therapy
• Klebsiella pneumoniae/isolation & purification
• Liver/pathology
• Liver Abscess/complications
• Liver Abscess/therapy
• Pulmonary Embolism/etiology
• Tomography, X-Ray Computed

• air embolism
• arterial air embolism
• brain air embolism
• cerebral air embolism
• cerebral arterial gas embolism
• gas embolism
• hyperbaric oxygen
• hyperbaric oxygen treatment
• upper gastrointestinal endoscopy

• adult intensive care
• mechanical ventilation
• neurology
• respiratory system

Cerebral air embolism is a known complication from a myriad of iatrogenic causes. This case describes a 60-year-old female presenting from hemodialysis with altered mental status, bilateral homonymous hemianopia, and repetitive speech. A noncontrast head CT revealed air in the vein of Galen and the deep cerebral veins of the left thalamus and occipital sulcus, a complication from air being introduced into the patient via improper flushing of dialysis tubing. The retrograde flow of air bubbles in the upright patient during dialysis was likely responsible for the air embolus lodging in the cerebral vasculature. This patient was transferred to receive hyperbaric therapy, whereupon the patient survived with residual attention and spatial deficits.

Venous air embolism is a dreaded condition particularly relevant to the field of nephrology. In the face of a favourable, air-to-blood pressure gradient and an abnormal communication between the atmosphere and the veins, air entrance into the circulation is common and can bring about venous air embolism. These air emboli can migrate to different areas through three major routes: pulmonary circulation, paradoxical embolism and retrograde ascension to the cerebral venous system. The frequent undesirable outcome of this disease entity, despite timely and aggressive treatment, signifies the importance of understanding the underlying pathophysiological mechanism and of the implementation of various preventive measures. The not-that-uncommon occurrence of venous air embolism, often precipitated by improper patient positioning during cervical catheter procedures, suggests that awareness of this procedure-related complication among health care workers is not universal. This review aims to update the pathophysiology of venous air embolism and to emphasize the importance of observing the necessary precautionary measures during central catheter use in hopes of eliminating this unfortunate but easily avoidable mishap in nephrology practice.

• air embolism
• catheter
• central vein
• haemodialysis
• retrograde pathway

• air embolism
• argon plasma coagulation(apc)
• arterial air embolism
• bronchoscopy
• end tidal co2
• nd-yag laser
• paradoxical embolism
• patent foramen ovale
• venous air embolism