Abstract 14896: Air Embolism and St Elevation Myocardial Infarction: A Systematic Review

Introduction: Air embolism has rarely been associated with ST- elevation myocardial infarction (STEMI). Limited data exists on the risks, management and outcomes of this phenotype of STEMI to guide clinicians. Method: We queried EMbase, PubMed and Cochrane database for cases of air embolism associated with STEMI to better understand this association, its complications and outcomes. Results: We identified thirty-six cases of systemic air embolism events associated with STEMI. A mean age of fifty-nine with male predominance was identified. Patent foramen ovale was identified in 22%. Periprocedural air emboli occurred 66% (24/36) and miscellaneous causes including scuba diving and positive pressure ventilation accounted for 33% (12/36). Six patients reported chest pain, eleven developed shock and four suffered cardiac arrest. Neurological symptoms were reported in eighteen patients (50%). ST elevations were noted in all cases. CT angiography detected air bubbles in ten patients and seven were detected via cardiac catheterization. Transthoracic echocardiography detected air bubbles in a ventricular cavity in seven patients, and thirteen had air bubbles demonstrated on CT brain. Hyperbaric oxygen was delivered to eleven patients, nine of whom also received high flow oxygen. Seven were placed in Trendelenburg position and two had catheter aspiration of air bubbles. All patients received supportive treatment. Thirteen (36%) patients died. Conclusion: Patients with periprocedural STEMI and unexplained neurological symptoms should have air embolism considered in the differential. If identified, patients should be treated as per STEMI guidelines along with early delivery of 100% oxygen, in hyperbaric setting if available. If patient is hemodynamically unstable for catheterization, CT and echocardiographic imaging are reasonable alternatives to establish the diagnosis.