Air embolism

Venous air embolism

Nature

Venous air embolism (VAE) is the entry of air into the venous system, as a consequence of trauma or iatrogenic complications (notably surgical procedures where venous structures (veins or venous sinuses) are open to air or when catheters are inserted into veins as in central venous cannulation or pressure infusion of fluids and blood). It has been identified as a component of decompression injury as well. VAE causes the heart to malfunction and pulmonary injury. It is associated with significant morbidity and mortality. Symptomatic VAE following central venous catheterization has mortality as high as 30%.

Background

VAE results when a pressure gradient develops between a source of air and the venous system, which favours ingress of air into the venous system. Small amounts of air do not produce symptoms as the air is removed from the circulation. Large boluses of air can cause acute right ventricular outflow obstruction and result in cardiogenic shock and circulatory arrest. Intermediate amounts of air end up in the pulmonary circulation and produce a pulmonary vascular injury. Symptoms, which develop immediately following embolization, are similar to pulmonary thromboembolism and include: dyspnea, chest pain, tachycardia and hypotension. The severity of the above symptoms is related to the degree of air entry. Severe cases will present in circulatory shock or sudden death.

Incidence

The true incidence of venous air embolism is unknown. Subclinical air embolism in hospitalized patients is possibly quite common. The frequency of clinically recognized VAE following central venous cannulation is less than 2%.

Claim

Air embolism is a critical and often overlooked medical emergency that can lead to severe complications or death. The introduction of air into the vascular system can occur during various medical procedures, yet awareness and preventive measures remain alarmingly inadequate. This silent threat demands urgent attention from healthcare professionals and policymakers alike. By prioritizing education, training, and stringent protocols, we can significantly reduce the incidence of air embolism and protect countless lives. Immediate action is essential!

Counter-claim

Air embolism is often overstated as a significant medical concern. In reality, it is a rare occurrence, primarily affecting specific high-risk situations like diving or certain medical procedures. The vast majority of healthcare practices effectively mitigate this risk, making it a non-issue for the general population. Focusing on air embolism distracts from more pressing health challenges that require attention and resources, rendering it an exaggerated problem that does not warrant the alarm it often receives.