Continuous renal replacement therapy in patients receiving extracorporeal membrane oxygenation therapy

Methods of continuous renal replacement therapy (CRRT) in extracorporeal membrane oxygenation (ECMO) patients include dedicated central venous cannula (CVC) (vCRRT), in-series with filter connected to ECMO circuit (eCRRT) or in-line with haemodiafilter incorporated within ECMO circuit. We assessed the efficacy and safety of eCRRT versus vCRRT in 20 ECMO-CRRT patients. Average filter lifespan was 42 vs 28 hours and filter runs completing 72hours were 40% vs 13.8% (eCRRT vs vCRRT, respectively). One incidence of ECMO circuit air embolus occurred (vCRRT). eCRRT achieved adequate filtration and increased filter lifespan, and has become our default for ECMO-CRRT if a pre-existing dialysis CVC is not present.

Uncommon Occurrence of an Air Embolism during the Preanhepatic Phase of an Orthotopic Liver Transplant

Vascular air embolism (VAE) during liver transplantation usually occurs during the dissection phase of the procedure or during liver reperfusion. If this phenomenon occurs, it can cause significant cardiovascular, pulmonary, and neurological complications. Prompt identification of VAE is essential, and the surgeon should be immediately notified. The mainstay treatment is identification and rectification of the source of the air embolus, hemodynamic support, and prevention of further air entrainment. This case report describes the occurrence of a pulmonary air embolism during the preanhepatic phase of an orthotopic liver transplant.

Systemic vascular air embolus following CT-guided transthoracic needle biopsy: a potentially fatal complication

Following an uncomplicated CT-guided transthoracic biopsy, a patient becomes unconscious and subsequently dies despite immediate cardiac resuscitation. The patient felt well during the procedure but started complaining about dizziness and chest pain when he sat up. When he again was put in a supine position, cardiac arrest was noted. A CT scan performed when the symptoms initiated was afterwards rigorously reviewed by the team and revealed air located in the left ventricle, aorta and right coronary artery.We present a rare but potentially lethal complication following CT-guided transthoracic needle biopsy—systemic vascular air embolus. Knowledge and evidence about the complication are sparse because of low incidence and varying presentation. However, immediate initiation of treatment can save a life, and awareness of the complication is therefore crucial.

Rare pathology in a trauma patient: air embolism following peripheral intravenous access

A 62-year-old man presented as a trauma alert after a farm tractor accident. He was managed according to ATLS protocol. During initial trauma resuscitation, he developed an iatrogenic air embolus. The patient was treated conservatively by positioning him head down and tilted to the left (Durant’s manoeuvre). Repeat CT scan performed 4 hours later showed resolution of the air embolus. He had no sequelae.

Left atrio-oesophageal fistula after atrial fibrillation ablation

We report a case of a 68-year-old woman who presented with atypical chest pain and fluctuating neurological symptoms 4 weeks after cryoballoon ablation procedure for atrial fibrillation. Brain imaging showed multiple embolic infarcts, while the chest imaging revealed an abnormal connection between the posterior wall of the left atrium and the oesophagus. Based on her clinical presentation and the imaging findings, a diagnosis of left atrio-oesophageal fistula (AOF) was established. AOF carries a high mortality rate unless an urgent surgical repair is performed. Oesophageal instrumentation for an echocardiogram or endoscopy should be avoided as it can result in massive air embolus, causing stroke or death.

Posterior Fossa

The posterior fossa houses essential brainstem nuclei, cranial nerves, cerebral vasculature, and mechanisms for cerebrospinal fluid drainage. Anesthetic considerations for posterior fossa surgery include thorough preoperative evaluation, intraoperative monitoring, and anesthetic planning to allow neurophysiological monitoring. Careful positioning is imperative to optimize surgical conditions and to risk stratify patients for complications, including venous air embolus. Venous air embolus is a common complication of posterior fossa surgery given the plentitude of venous channels in the posterior fossa, and rapid recognition is key to managing this complication. Posterior fossa surgery also has a number of other known complications including postoperative apnea, prolonged ventilation, and possible brainstem stroke. This review contains 4 tables, 1 video, and 31 references. Keywords: Posterior fossa surgery, Brainstem surgery, Neuroanesthesiology, Venous air embolism/embolus, Sitting craniotomy, Prone craniotomy, Transesophageal echocardiogram, Neurophysiologic monitoring