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Izzat MB. Effective handling of substantial arterial air embolization during extracorporeal perfusion. Clin Case Rep 2019; 7:2568-2570. [PMID: 31893101 PMCID: PMC6935650 DOI: 10.1002/ccr3.2510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 09/17/2019] [Accepted: 09/26/2019] [Indexed: 11/05/2022] Open
Abstract
This report highlights the need for a coordinated approach to substantial arterial air embolization, considering the high risk of neurologic injury. Appropriate management may involve systemic hypothermia, hyperoxia, and retrograde cerebral perfusion.
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Quintero OL, Giraldo JC, Sandoval NF. Successful Management of Massive Air Embolism During Cardiopulmonary Bypass Using Multimodal Neuroprotection Strategies. Semin Cardiothorac Vasc Anesth 2018; 23:324-332. [DOI: 10.1177/1089253218819782] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Complications and critical events during cardiopulmonary bypass (CPB) are very challenging, difficult to manage, and in some instances have the potential to lead to fatal outcomes. Massive cerebral air embolism is undoubtedly a feared complication during CPB. If not diagnosed and managed early, its effects are devastating and even fatal. It is a catastrophic complication and its early diagnosis and intraoperative management are still controversial. This is why the decision-making process during a massive cerebral air embolism represents a challenge for the entire surgical, anesthetic, and perfusion team. All caregivers involved in this event must synchronize their responses quickly, harmoniously, and in such a way that all interventions lead to minimizing the impact of this complication. Its occurrence leaves important lessons to the surgical team that faces it. The best management strategy for a complication of this type is prevention. Nevertheless, a surgical team may ultimately be confronted with such an occurrence at some point despite all the prevention strategies, as was the case with our patient. That is why, in each institution, no effort should be spared to establish cost-effective strategies for early detection and a clear and concise management protocol to guide actions once this complication is detected. It is the duty of each surgical team to determine and clearly organize which strategies will be followed. The purpose of this case study was to demonstrate that a massive air embolism can be rapidly detected using near-infrared spectroscopy monitoring and can be successfully corrected with a multimodal neuroprotection strategy.
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Affiliation(s)
- Olga L. Quintero
- Universidad del Rosario, Bogotá, Colombia
- Fundación Cardioinfantil Instituto de Cardiología, Bogotá, Colombia
| | - Juan C. Giraldo
- Universidad del Rosario, Bogotá, Colombia
- Fundación Cardioinfantil Instituto de Cardiología, Bogotá, Colombia
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Anan'ev EP, Polupan AA, Savin IA, Goryachev AS, Troitskiy AP, Kolokol'nikov AE, Kulikovskiy VP, Matskovskiy IV, Abramov TA, Podlepich VV, Krylov KY, Sychev AA, Tabasaranskiy TF, Pashin AA, Lubnin AY. [Paradoxical air embolism resulted in acute myocardial infarction and massive ischemic brain injury in a patient operated on in a sitting position]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2016; 80:84-92. [PMID: 27070262 DOI: 10.17116/neiro201680284-92] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Paradoxical air embolism (PAE) is a rare life-threatening complication when air emboli enter arteries of the systemic circulation and cause their occlusion. Here, we describe a clinical case of PAE developed during neurosurgery in a patient in the sitting position. PAE led to injuries to the cerebral blood vessels, coronary arteries, and lungs, which caused death of the patient. An effective measure for preventing PAE is abandoning surgery in the sitting position in favor of surgery in the prone position.
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Affiliation(s)
- E P Anan'ev
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - A A Polupan
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - I A Savin
- Burdenko Neurosurgical Institute, Moscow, Russia
| | | | | | | | | | | | - T A Abramov
- Burdenko Neurosurgical Institute, Moscow, Russia
| | | | - K Yu Krylov
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - A A Sychev
- Burdenko Neurosurgical Institute, Moscow, Russia
| | | | - A A Pashin
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - A Yu Lubnin
- Burdenko Neurosurgical Institute, Moscow, Russia
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Weiner MM, Wicker J, Fischer GW, Adams DH, Bronster D, Evans AS, Murkin JM, Grocott HP. CASE 5–2015. J Cardiothorac Vasc Anesth 2015; 29:791-6. [DOI: 10.1053/j.jvca.2014.10.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Indexed: 01/19/2023]
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Neema PK, Pathak S, Varma PK, Manikandan S, Rathod RC, Tempe DK, Tung A. Case 2--2007: Systemic air embolization after termination of cardiopulmonary bypass. J Cardiothorac Vasc Anesth 2007; 21:288-97. [PMID: 17418752 DOI: 10.1053/j.jvca.2006.09.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2005] [Indexed: 11/11/2022]
Affiliation(s)
- Praveen Kumar Neema
- Department of Anesthesiology, Sree Chitra Tirunal Institute for Medical Science and Technology, Kerala, India.
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