Prevalence of systemic air-embolism after prolonged cardiopulmonary resuscitation in newborns: A pilot study

Vascular Air Embolism in Neonates: A Literature Review

Neonatal vascular air embolism is a rare but often fatal condition. The literature comprises mostly case reports and a few dated systematic reviews. Our objective was to review all case reports of neonatal vascular air embolism to date and provide up-to-date information about patient characteristics, clinical presentations, outcomes, pathogenesis, diagnosis, prevention, treatment, and prognosis. We searched the literature for case reports of neonatal vascular air embolism, using MEDLINE, CINAHL, and EMBASE, and the keywords "neonates" and "vascular air embolism." Results were summarized. There were 117 cases of neonatal vascular air embolism, with a mean gestational age of 30.4 weeks (range: 23-40), mean birth weight of 1,422 g (range 830-3,844), and median age of occurrence of 2 days (range: 1-540) after birth. The majority were preterm (75.2%), male (62.7%), on assisted respiratory support (90.5%), and had air leak syndrome (52.9%). The most common clinical presentation was sudden acute clinical deterioration, sometimes accompanied by crying, cardiac rhythm abnormalities, skin discoloration, and a decrease in end-tidal carbon dioxide concentration. Incidence of mortality and adverse neurological sequelae among survivors was 73.9 and 16.6%, respectively, overall, but significantly (p < 0.05) higher among preterm infants (81.8 and 31.2%, respectively) and lower among surgical infants (23.8 and 0%, respectively). Diagnosis included visualizing air in infusion lines or retinal vessels, a decrease in the end-tidal carbon dioxide levels, and radiographic, doppler ultrasound, transesophageal echocardiography, or computed tomography (CT) imaging. The prognosis for neonatal air embolism is poor, especially for preterm infants requiring mechanical ventilation. Prevention is key and treatment is supportive. KEY POINTS: · Vascular air embolism is a rare but often fatal neonatal condition that is often underrecognized.. · Preterm infants on mechanical ventilation and with air leak syndromes are at particular risk.. · Prognosis is poor, prevention is key, and treatment is supportive..

Pneumocephalus in a patient with multiple stab wounds

Pneumocephalus is a complication of trauma to the chest and many iatrogenic interventions. It may arise due to systemic air embolism or retrograde cerebral venous air embolism which is an extremely rare complication. We report a 26-years-old female patient who presented to the Emergency Department suffering of multiple stab wounds. She was in a state of shock and after first aid and evaluation she was operated successfully. In the early postoperative period generalized tonic clonic convulsions were observed following cardiopulmonary resuscitation due to sudden cardiovascular collapse. Brain computerized tomography demonstrated free air in intracranial and extracranial venous structures. Pneumocephalus was diagnosed which may be due to a wide spectrum of etiologies including thorax or spinal stab wounds, tube thoracostomy, cardiopulmonary resuscitation or even central venous catheterization. Unfortunately, the patient ended up with brain death despite all effort. In conclusion, we recommend physicians to be aware of this catastrophic complication while taking care of patients with stab wounds.

Systemic air embolism complicating upper gastrointestinal endoscopy: a case report with post-mortem CT scan findings and review of literature

Endoscopy of the gastrointestinal and biliary tract is a common procedure and is routinely performed for therapeutic and diagnostic purposes. Perforation, bleeding and infection are some of the more common reported side effects. Air embolism on the other hand, is a rare complication of gastrointestinal endoscopy. We report a 77-year-old African-American female with a history of pancreatic cancer, which was resected with a Whipple procedure. As part of diagnostic and therapeutic procedure, an endoscopic retrograde cholangiopancreatography was planned several months after the surgery. The patient's heart rate suddenly slowed to 40 bpm during the procedure and she became cyanotic and difficult to oxygenate after the endoscope was introduced and CO₂ gas was insufflated. A forensic autopsy was performed with post-mortem computed tomography (PMCT) and revealed extensive systemic air embolism. The detailed PMCT and autopsy findings are presented and current literature is reviewed.