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Fatal systemic air embolism in a neonate after cardiopulmonary resuscitation.

Qazi AQ, Haider ZA, Najam Y - APSP J Case Rep (2015)

View Article: PubMed Central - PubMed

Affiliation: Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan.

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Amongst the many causes proposed, vigorous cardiopulmonary resuscitation and intravenous infusion/pump have long been suspected... However in the same evening he suddenly collapsed with cyanosis, bradycardia and severe hypoxemia... Cardiopulmonary resuscitation was carried out with endotracheal intubation but declared unsuccessful after 30 minutes... A chest X-ray was taken in search of aetiology of sudden collapse after 30 minutes of resuscitation... This revealed significant volume of air in the right atrium, systemic and pulmonary vasculature (Fig.1)... The possibility of this via a 24G peripheral venous cannula through automated infusion pump does not seem a practical possibility in the wake of massive air embolism delineating the entire systemic and pulmonary vasculature... The automated pumps have built in safety mechanism to stop functioning in the presence of air bubbles and bleeps alarm but there have been cases reported where alarm did not go off but the patient collapsed and could not be revived and autopsy showed air in the cardiac chambers.[2] However the volume of air infused was very small and only possible to identify on cardiac echo... Air embolism after resuscitation has been often reported in literature but this is usually observed in cerebral vasculature.[3,4] Systemic air embolism has been reported in premature infants on artificial ventilation as a result of baro-trauma as well as after necrotizing enterocolitis.[5,6] There is only a single case report in literature with systemic air embolism in a premature infant who collapsed suddenly due to a clot in inferior vena cava.[6] It is hypothesized that there is disruption of pulmonary vasculature during resuscitation, which leads to air entry from the alveoli, possibly because of frail tissues/vasculature in newborns... There are reports of systemic air embolism associated with assisted ventilation in premature infants.[7] An early suspicion of diagnosis, urgent echo at the time of collapse and initiation of treatment for systemic air embolism may play a role in saving life in such a scenario... Medical equipment should also be critically checked at regular intervals by the relevant electromedical department for any malfunction... These possible explanations may be kept in mind while investigating cause of demise in similar situations... Nil None declared

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Related in: MedlinePlus

Figure 1:Massive systemic air embolism, delineating air contrast in both venous and arterial vasculature and a large volume in all four chambers of the heart.
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Figure 1: Figure 1:Massive systemic air embolism, delineating air contrast in both venous and arterial vasculature and a large volume in all four chambers of the heart.


Fatal systemic air embolism in a neonate after cardiopulmonary resuscitation.

Qazi AQ, Haider ZA, Najam Y - APSP J Case Rep (2015)

Figure 1:Massive systemic air embolism, delineating air contrast in both venous and arterial vasculature and a large volume in all four chambers of the heart.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4288831&req=5

Figure 1: Figure 1:Massive systemic air embolism, delineating air contrast in both venous and arterial vasculature and a large volume in all four chambers of the heart.

View Article: PubMed Central - PubMed

Affiliation: Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Amongst the many causes proposed, vigorous cardiopulmonary resuscitation and intravenous infusion/pump have long been suspected... However in the same evening he suddenly collapsed with cyanosis, bradycardia and severe hypoxemia... Cardiopulmonary resuscitation was carried out with endotracheal intubation but declared unsuccessful after 30 minutes... A chest X-ray was taken in search of aetiology of sudden collapse after 30 minutes of resuscitation... This revealed significant volume of air in the right atrium, systemic and pulmonary vasculature (Fig.1)... The possibility of this via a 24G peripheral venous cannula through automated infusion pump does not seem a practical possibility in the wake of massive air embolism delineating the entire systemic and pulmonary vasculature... The automated pumps have built in safety mechanism to stop functioning in the presence of air bubbles and bleeps alarm but there have been cases reported where alarm did not go off but the patient collapsed and could not be revived and autopsy showed air in the cardiac chambers.[2] However the volume of air infused was very small and only possible to identify on cardiac echo... Air embolism after resuscitation has been often reported in literature but this is usually observed in cerebral vasculature.[3,4] Systemic air embolism has been reported in premature infants on artificial ventilation as a result of baro-trauma as well as after necrotizing enterocolitis.[5,6] There is only a single case report in literature with systemic air embolism in a premature infant who collapsed suddenly due to a clot in inferior vena cava.[6] It is hypothesized that there is disruption of pulmonary vasculature during resuscitation, which leads to air entry from the alveoli, possibly because of frail tissues/vasculature in newborns... There are reports of systemic air embolism associated with assisted ventilation in premature infants.[7] An early suspicion of diagnosis, urgent echo at the time of collapse and initiation of treatment for systemic air embolism may play a role in saving life in such a scenario... Medical equipment should also be critically checked at regular intervals by the relevant electromedical department for any malfunction... These possible explanations may be kept in mind while investigating cause of demise in similar situations... Nil None declared

No MeSH data available.


Related in: MedlinePlus