Position change during hyperbaric oxygen therapy for arterial gas embolism

Arterial gas embolism can be fatal and should be treated with care. Typically, the patient is placed in the supine position during treatment. However, we present a case where the patient's position was changed to facilitate treatment. A 78-year-old man with severely reduced heart function underwent cryoablation for chronic atrial fibrillation. During the procedure, he accidentally inhaled rapidly. Subsequently, he presented with stroke symptoms. Computed tomography (CT) revealed air in the brain and left ventricle, leading to a diagnosis of arterial gas embolism. He underwent hyperbaric oxygen (HBO₂) therapy as per the US NAVY Table 6 protocol. The air embolism in the brain reduced but that in the apex of the left ventricle persisted. Subsequently, HBO₂, as per the US NAVY Table 5 protocol, was performed along with a position change to the right lateral and manual vibration. The position change was based on the three-dimensional structures of the left ventricle, aortic arch, and descending aorta. Subsequently, no air was observed on CT, and rehabilitation was initiated. Safe body positions for arterial and venous gas embolisms differ. Therefore, understanding the vascular anatomy is imperative for treating gas embolism.