DDRC Healthcare, Plymouth, Devon

Emergencies & Hyperbaric Referrals
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Gas Embolism for Professionals

To refer a patient please follow this link.

For more information on the patient experience please follow this link.

The vast majority of individuals with gas embolism that we treat are divers with arterial gas embolism (AGE), following pulmonary barotrauma during a dive. 

Of course arterial or venous gas embolism can occur for many other reasons, mostly iatrogenic.

AGE can be seen as a result of

  • Mechanical ventilation
  • Penetrating chest trauma
  • Chest tube insertion
  • Bronchoscopy

The venous system is also often exposed to the possibility of excess gas being injected iatrogenically as well. For example,

  • Accidental IV injection
  • Bypass accidents
  • During haemodialysis
  • CV line insertion/disconnection
  • GIendoscopy/arthroscopy
  • Laparoscopy/TURP
  • Surgical wounds higher than the heart, e.g. sitting craniotomy.

An individual can tolerate up to 20ml/min IV of gas, whereas volumes tolerated directly into arterial system are much lower. There is limited data on the exact volume.

Air within the circulation will create different pathology depending on its location and volume. Air within the heart can lead to a “vapour lock” resulting in circulatory compromise thus hypotension and cardiac arrest. It could also cause arrhythmias and or ischaemia if passes into the cardiac vessels.

Bubbles may pass into the cerebral circulation and manifest as general reduction in GCS or focal neurology depending on their location.

Treatment entails up to 10 sessions of HBO over a 2 week period subject to response to treatment.

References

The Royal College of Surgeons of Edinburgh

Diploma in Remote and Offshore Medicine

Details found at http://www.rcsed.ac.uk/education/academic-programmes/remote-and-offshore-medicine/rom-cpd.aspx (Accessed July 2015)

 

Blanc (2002)

Blanc P. Boussuges A, Henriette K, etal

“Iatrogenic cerebral air embolism: importance of an early hyperbaric oxygenation.”

Intensive Care Med

2002 May;28(5):559-63

Epub 2002 Mar21

 

Moon (2014)

Moon RE

“Hyperbaric oxygen treatment for air or gas emobolism”

Undersea Hyperb Med

2014 Mar-Apr;41(2):159-66

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