Update on the Management of Iatrogenic Gas Embolism

Abstract

Gas embolism is defined by the clinical manifestations occurring following the entry of gas into a vessel. It may occur during trauma, pregnancy, or as a consequence of medical or surgical procedures, i.e., iatrogenic gas embolism. The prevalence of iatrogenic gas embolism is estimated at about 2.6/100,000 hospitalizations. Severe sequelae affect 9–35% of survivors. Mortality is approximately 8–12%. There are numerous at-risk procedures for gas embolism, among the most common being laparoscopy, neurosurgery, cardiopulmonary bypass, placement, manipulation or removal of central venous lines, thoracic punctures. Diagnosis is definite when gas is observed in the cardiovascular system and should be suspected if there is sudden cardiac arrest or cardiovascular collapse, or onset of dyspnea, chest pain, seizures, neurological deficit particularly when multifocal and transient. During general anesthesia, a decrease in end-tidal CO2 is a common sign of gas embolism. Treatment of gas embolism requires that the patient be placed immediately in the supine or Trendelenburg position and on high concentration oxygen therapy, the invasive procedure be terminated as soon as possible, gas removed from cardiac cavities whenever possible, volume expansion, and prompt hyperbaric oxygen therapy.