2009).Ĭlinicians are trained to reduce AE risk by priming intravenous tubing and use devices including Luer-lock connectors, filters, and modern infusion systems which may alarm on detection of AE. Systemic inflammatory response syndrome (SIRS) can also result from AEs (Kapoor and Gutierrez 2003 Hsieh et al. The closer the air entry to the right heart, the lesser the volume of air required to cause fatality (McCarthy et al. 2007 Brull and Prielipp 2017 Vesely 2001 Foster et al. This phenomenon provides considerable risk since most PFOs are undiagnosed and occur in 10 to 25% of the population (Mirski et al. In cases of large venous AE, the filter capacity of the pulmonary capillary bed becomes overwhelmed and air may translocate to the arterial circulation, more often in patients with a patent foramen ovale (PFO) as well as an ASD or VSD, thereby allowing direct air passage from the venous to arterial system (Girard et al. 2009).Ī paradoxical AE occurs when venous air enters arterial circulation, such as in the case of an atrial or ventricular septal defect (ASD and VSD). Larger volumes of venous air can increase pulmonary artery pressure and right ventricular strain, resulting in systemic cardiovascular collapse (Muth and Shank 2000 Agarwal et al. Ultimately, this may result in cellular injury and lung edema (van Hulst et al. However, studies demonstrate that entrapment of venous air in the pulmonary microcirculation can decrease gas exchange and cause pulmonary vascular obstruction, potentially leading to release of vasoactive mediators. When entering the venous system in healthy individuals, air is usually broken up in the capillary bed of the lungs. AEs may be comprised of atmospheric air or medical gases including nitrous oxide, carbon dioxide, helium, and nitrogen (Mitchell et al. AEs may enter the vasculature during major surgeries such as neurosurgery, or during less complex procedures including administration of medications, fluids, or blood products through intravenous tubing, intravenous catheter placement, or during diagnostic procedures (Bayliss et al. 2007 Orliaguet and Martin 2000 Brull and Prielipp 2017). The impact of AEs depends upon factors including the patient’s physiology, size of the air mass, and the path air takes through the anatomy (Mirski et al. Once air enters the patient, symptoms range from subtle physiologic changes to potentially catastrophic events. Intravascular air embolism (AE) occurs when undesired air enters the venous or arterial circulation, typically during medical procedures (Mirski et al. ConclusionĪn air purging system reduced air burden from bolus administration and could consequently reduce the risk of harmful or fatal AEs during surgery. ResultsĪll subjects demonstrated significantly lower air burden when the air reduction device was used ( p = 0.004), and the average time to clear 90% of air was also lower, 3.7 ± 1.2 s vs. Air was quantified using optical densitometry (OD) from images demonstrating maximal air in the RA. The TEE was positioned in the mid-esophageal right atrium (RA) to quantify peak air clearance, and images were video recorded throughout each bolus. For each bolus, a bulb infuser was squeezed three times (10–15 mL) over 5 s. Each patient received four randomized fluid boluses: two with the in-line air purging device, two without. Six patients undergoing cardiac surgery were studied. After general anesthesia was induced, an introducer and pulmonary artery catheter was inserted in the right internal jugular to administer fluids and monitor cardiac pressures. Subjects were observed using standard monitors, including transesophageal echocardiography (TEE) in the operating room.
RAPID AIR LINE SYSTEMS SERIES
MethodsĪ prospective, randomized, case series was conducted. A novel FDA-approved in-line air detection and purging system was used to detect and remove air caused by administering a rapid fluid bolus during surgery. The potentially fatal risks of arterial AE are well-known, and emerging evidence demonstrates impact of venous AEs on inflammatory response and coagulation factors. Intravascular air embolism (AE) is a preventable but potentially catastrophic complication caused by intravenous tubing, trauma, and diagnostic and surgical procedures.