Low Consciousness in a Patient with Venous Air Embolism Introduced via Peripheral Vascular Cannulation

Introduction: Venous air embolism is rarely seen, can be fatal and is associated mostly with large central venous catheters and mechanical ventilation. Some cases due to peripheral intravenous access have also been reported. Case Description: We present a case of intracranial venous air embolism most likely secondary to peripheral cannulation. On admission, the patient was drowsy with a suddenly deteriorating Glasgow coma scale score. This case emphasizes cautious cannula insertion and close monitoring of the patient in the event of complications. Conclusion: Intravenous cannulation is common but care should be taken to avoid catastrophic complications. Consider air embolism as the differential diagnosis if a patient has a low level of consciousness after an intravenous cannula is inserted.

Caution: Air Embolism Related to Heli-Fx EndoAnchor System in Zone 2 Thoracic Aneurysm Repair

Purpose We report a case of significant air embolization to the ascending aorta immediately following deployment of EndoAnchors in the aortic arch during a procedure to correct a type 1A endoleak. Case report The novel Heli-Fx EndoAnchor system (Medtronic Vascular, Santa Rosa, CA, USA) was used to deploy helical anchors in the distal aortic arch during a procedure to correct a type 1A endoleak following Zone 2 thoracic endovascular aortic repair of a saccular proximal descending thoracic aorta aneurysm (DTAA). The patient developed ST-segment elevations principally in the inferior leads and severe hypotension moments after EndoAnchor deployment at the proximal edge of the endograft. Transesophageal echocardiogram revealed severe right ventricular hypokinesis and a large amount of air in the ascending aorta. Subsequent management and clinical and radiological 30-day follow-up is presented in addition to a review of the literature and ex vivo testing with the Heli-Fx system to examine potential causes and solutions. Conclusion Precautions, such as pressurized saline infusion to the side port of guiding sheath, should be used whenever manipulating catheters and sheaths such as the EndoAnchor system in the aortic arch to prevent this potentially lethal complication.

Unusual complications of the central venous catheterization in trauma patients

Central venous catheters (CVCs) are commonly used in patients with trauma. The placement and removal of the CVCs can result in various complications regardless of the skill of the professionals. Herein, two cases of rare complications are presented— an inadvertent subclavian artery catheterization and a cerebral air embolism after a CVC removal. Moreover, practical solutions for each complication are provided in detail.

Design and 3D-model of a dynamic bubble trap for cardiopulmonary bypass

The use of extracorporeal circulation systems (cardiopulmonary bypass pumps, ECMO) can lead to brain and coronary artery microembolism, which significantly reduces postoperative rehabilitation and often leads to severe complications. Microembolism occurs when oxygen or air microbubbles (MBs) enter the arterial system of patients. Existing CPB pumps come with built-in bubble trap systems but cannot remove bubbles in the circuit. ECMO devices have arterial filters but cannot reliably filter out <40 μm bubbles in a wide flow range. We have proposed an alternative method that involves the use of an efficient dynamic bubble trap (DBT) for both large and small bubbles. The design includes development of two DBT variants for hemodynamic conditions of adult and pediatric patients. The device is installed in the CPB pump and ECMO outlet lines. It provides sufficient bubble separation from the lines in a blood flow of 3.0–5.0 L/min for adults and 0.5–2.0 L/min for children. The developed computer models have shown that MBs smaller than 10 μm can be filtered. The use of this device will greatly reduce the likelihood of air embolism and provide the opportunity to reconsider the concept of expensive arterial filters.