Hyperbaric oxygen therapy of iatrogenic cerebral arterial gas embolism

We describe our experience using HBO2 therapy for iatrogenic cerebral arterial gas embolism (CAGE) in this retrospective review of nineteen patients treated for iatrogenic CAGE, from 1987 to 1999. Immediately after treatment, five patients completely resolved all signs and symptoms, eleven had improvement, one had no change, and two were not assessable. Within two months post treatment, three additional patients completely resolved and six had further improvement. Patients with a venous source all experienced pulmonary signs or symptoms, with eight of nine chest x-rays demonstrating pulmonary edema. Patients with an arterial source had no pulmonary symptoms; all chest x-rays were clear. Imaging studies prior to HBO2 therapy demonstrated gas in six of 23 exams; five of the remaining 17 exams showed secondary changes consistent with gas embolism. Iatrogenic CAGE patients improved with HBO2 therapy, and improvement for some continued for several months. Patients with CAGE from a venous source have pulmonary signs or symptoms. Diagnosis of CAGE should be made on clinical suspicion without reliance on imaging studies.