Quick diagnosis of venous air embolism

Excerpt

A 38-year-old man with idiopathic dilated cardiomyopathy and chronic atrial fibrillation presented with symptoms of heart failure. He underwent temporary override pacemaker insertion through right femoral access. A few hours later, he developed shock. Central venous (femoral) and arterial (radial) cannulations were performed for organ support and monitoring. In spite of cardiorespiratory support, his lactate level increased steadily. A CT scan was done to rule out mesenteric ischemia. Bedside echocardiography was performed to identify the type of shock. It showed gross air in the inferior vena cava and right ventricle as well as a dilated right ventricle with flattened interventricular septum and low ejection fraction (Video 1; Fig. 1). Management of air embolism was initiated with 100% oxygen, steep head-down with left lateral decubitus positioning, and aspiration of air through a newly inserted right atrial catheter. The patient developed acute kidney injury for which renal replacement therapy was instituted. CT scan confirmed presence of air in the inferior vena cava (IVC), femoral and hepatic veins (Fig. 1). Follow-up echocardiography showed resolution of air.

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