Air Embolism


Air Embolism, Air Embolus, Gas Embolism, Gas Embolus, Vascular Air Embolism

  • Definitions
  1. Air Embolism
    1. Rare but catastrophic obstruction of blood vessels due to introduction of air or gas into the venous circulation
  • Causes
  1. Central venous catheterization (may occur in up to 0.2% to 1%)
    1. More common with head and neck procedures
  2. Cardiac bypass
  3. Blunt or Penetrating Trauma
  4. Scuba Diving Injury (see Arterial Gas Embolism)
  5. Child birth
  6. Hemodialysis Emergency
  • Findings
  1. Specific to site of embolism-related obstruction
  2. Pulmonary Air Embolism
    1. Presents similarly to Pulmonary Embolism (e.g. Chest Pain, Dyspnea)
  3. Cardiac Findings
    1. "Millwheel" Heart Murmur may be present
  4. Cerebral Air Embolism
    1. Altered Mental Status
    2. Focal Neurologic Deficits
    3. Seizure
  • Management
  1. ABC Management
  2. Apply 100% FIO2 to facilitate dissolving air in blood
  3. Consider early hyperbaric chamber (within 6 hours)
  4. Place patient in trendelenburg and left lateral recombent position (Durant's Maneuver)
    1. Postulated to keep air in right atrial apex and prevent passage into pulmonary circulation
  5. Advance central venous line into the right heart and ventricular outflow and attempt to aspirate air
  1. Flush Central Lines to remove air
  2. Apply Occlusive Dressing when changing Central Lines
  3. Patient should perform Valsalva Maneuver when the line is being removed
  4. Confirm caps on all intravenous lines
  5. Clamp any Central Line that is leaking
  • References
  1. Guest and Sawyer in Swadron (2022) EM:Rap 22(7): 11-2
  2. Gordy (2013) Int J Crit Illn Inj Sci 3(1):73-6 +PMID: 23724390 [PubMed]