Rapid detection of venous air embolism by mass spectrometry during bone marrow harvesting

An episode of venous air embolism occurred in a 13-year-old girl undergoing bone marrow harvest for an autologous bone marrow transplant. The diagnosis was suspected with the sudden appearance of tachycardia and a new heart murmur during inadvertent application of positive pressure to marrow aspiration needles. Decreased carbon dioxide and increased nitrogen content of end-tidal expiratory gases was detected by continuous mass spectrometric monitoring. Cessation of faulty aspiration technique and application of positive end expiratory pressure with 100% oxygen prevented a potentially fatal complication. Venous air embolism may complicate bone marrow harvest. Mass spectrometric monitoring of end-tidal gases is useful for rapid, early detection of this complication.