Air embolism- Incidence of Uncommon Causes, Diagnostic and Treatment Challenges

Abstract

An air embolism is a condition in which air or gas enters the vasculature in either the venous or arterial systems resulting in an obstruction of circulation potentially leading to serious complications such as acute stroke, respiratory arrest, cardiac arrest, or myocardial infarction. While the etiology of most air embolisms is iatrogenic from interventions such as invasive procedures, hemodialysis or neurosurgery, it is also important to recognize uncommon causes of air embolisms. These uncommon causes include decompression (i.e., from scuba diving), percutaneous transthoracic lung biopsy, cardiopulmonary bypass, intraabdominal laparoscopic surgery and ventilator associated air embolism. The most common pathophysiology is based on pressure difference in the vasculature, others include direct trauma or paradoxical air embolism. The clinical presentation of venous and arterial air embolisms is variable, atypical, and depends on volume of air, rate, route of entry, organs affected; making diagnosis challenging. Diagnostic methods include imaging modalities such as Echocardiogram, Transesophageal echocardiography (TEE), Point of care ultrasound (POCUS), Doppler ultrasonography, Computed tomography (including CT pulmonary angiogram), Magnetic resonance imaging. Treatment is based on the type and severity of embolism as well as the patient’s hemodynamic status. It requires supportive care and definitive treatment like hyperbaric oxygen therapy, aspiration or Extra-corporeal membrane oxygenation (ECMO) in severe cases. Air embolism comes with its own diagnostic challenges-atypical clinical presentation, low sensitivity of most imaging techniques, lack of clinical awareness, and treatment challenges-limited availability of hyperbaric oxygen chambers, lack of standardized treatment protocols, limited data on adjunctive treatment methods. Proposed solutions for these challenges include emphasizing on standardization of diagnostic and treatment protocols, artificial intelligence integration, rapid imaging access, continued medical education, referral networks for HBOT and evidence-based research.