Management of Suspected Air Embolism
For suspected air embolism, immediately place the patient in the left lateral decubitus position, administer 100% oxygen, and provide fluid resuscitation while preparing vasopressors for hypotension management. 1, 2
Clinical Recognition and Assessment
- Assess for respiratory symptoms including tachypnea, dyspnea, cyanosis, and hypoxemia, which are common manifestations of air embolism 1
- Monitor for cardiovascular signs such as hypotension, tachycardia, jugular venous distension, and new heart murmurs 1
- Evaluate for neurological manifestations, including altered mental status, seizures, or focal neurological deficits, which may indicate cerebral air embolism 1
- Use pulse oximetry and arterial blood gas analysis to assess oxygenation status 1
Emergency Management Protocol
Immediate Actions
- Position the patient in the left lateral decubitus position to prevent air from migrating to the pulmonary artery 3
- Administer normobaric 100% oxygen to reduce the size of air bubbles and improve tissue oxygenation 3, 4
- Initiate fluid resuscitation to increase central venous pressure 1
- Prepare vasopressors for management of hypotension 1
- Initiate CPR if cardiac arrest occurs 1, 5
Additional Interventions
- If a central venous catheter is in place, attempt to aspirate air bubbles from the right atrium 3, 2
- For arterial air embolism with neurological symptoms, consider hyperbaric oxygen therapy (HBOT) if available 3, 6
- For venous air embolism, place the patient in the left lateral decubitus and/or Trendelenburg position 2
Special Considerations
- Air embolism is primarily iatrogenic, with vascular access-related procedures accounting for approximately 33% of cases 6
- Mortality rate can be as high as 21%, with 69% of deaths occurring within 48 hours 6
- Patients who experience immediate cardiac arrest have a significantly higher mortality rate (53.8% vs. 13.5%) 6
- Hyperbaric oxygen therapy is the definitive treatment for significant air embolism as it decreases bubble size through gas reabsorption while improving tissue oxygenation 2
- Air embolism can cause injury by obstructing blood flow from the right side of the heart and through pulmonary vasoconstrictive mechanisms 4
Prevention Strategies
- Use proper technique during central venous catheter placement and removal 7
- Maintain proper patient positioning during high-risk procedures 7
- Ensure all connections in IV lines are secure 7
- Use air-eliminating filters in IV lines when appropriate 7
- Maintain adequate hydration in patients with central venous catheters 7