Position change during hyperbaric oxygen therapy for arterial gas embolism.

Area of Science:

• Cardiology
• Neurology
• Vascular Surgery

Background:

• Arterial gas embolism (AGE) is a life-threatening condition often treated with patients in the supine position.
• Standard treatment protocols for AGE may not always be optimal, especially in patients with complex cardiac anatomy.

Purpose of the Study:

• To report a case of arterial gas embolism following cryoablation for atrial fibrillation.
• To describe the successful use of a modified patient position during hyperbaric oxygen therapy for persistent left ventricular air embolism.

Main Methods:

• A 78-year-old male patient diagnosed with AGE after cryoablation presented with stroke symptoms.
• Initial treatment involved hyperbaric oxygen (HBO2) therapy using US NAVY Table 6.
• Persistent left ventricular air embolism necessitated a change in HBO2 protocol (US NAVY Table 5) combined with a right lateral decubitus position and manual vibration.

Main Results:

• Computed tomography (CT) confirmed air in the brain and left ventricle.
• Initial HBO2 therapy reduced cerebral air but left ventricular air persisted.
• The modified treatment, including position change, successfully resolved the left ventricular air embolism as confirmed by CT.

Conclusions:

• Patient positioning is a critical, yet often overlooked, factor in managing arterial gas embolism.
• Understanding detailed vascular anatomy is essential for tailoring treatment strategies in AGE.
• This case demonstrates the potential benefit of individualized positioning in conjunction with hyperbaric oxygen therapy for complex AGE cases.