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Arterial gas embolism and hemoconcentration

R M Smith1, K B Van Hoesen, T S Neuman

  • 1Department of Medicine, School of Medicine, University of California, San Diego, La Jolla.

The Journal of Emergency Medicine
|March 1, 1994
PubMed
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Arterial gas embolism in divers causes hemoconcentration, indicated by a drop in hematocrit. The severity of this hemoconcentration correlates with neurological outcomes, suggesting complex pathophysiology.

Area of Science:

  • Diving Medicine
  • Neurology
  • Pathophysiology

Background:

  • Diving-related accidents can cause serious neurological deficits.
  • Arterial gas embolism (AGE) is a known complication of diving.

Purpose of the Study:

  • To investigate the hematological changes in patients with arterial gas embolism.
  • To determine the relationship between hematocrit levels and neurological outcomes in AGE patients.

Main Methods:

  • Retrospective review of patient charts (1983-1991) with diving-related accidents.
  • Defined AGE based on neurological deficit, timing, and dive profile.
  • Analyzed initial and final hematocrit levels for 23 patients.

Main Results:

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  • A significant decrease in hematocrit was observed from initial presentation to discharge/death.
  • No significant blood loss was identified as a cause for hematocrit changes.
  • The magnitude of hematocrit fall correlated significantly with the severity of neurological deficit.

    • Conclusions:

    • Arterial gas embolism leads to hemoconcentration, not solely due to blood loss.
    • The degree of hemoconcentration is a predictor of neurological outcome severity in AGE.
    • AGE pathophysiology likely involves diffuse endothelial injury and fluid extravasation, beyond simple gas embolism.