Bessereau J, Genotelle N, Chabbaut C, Huon A, Tabah A, Aboab J, et al. Long-term outcome of iatrogenic gas embolism. Intensive Care Medicine. 2010;36(7):1180-7.
Ploner F, Saltuari L, Marosi MJ, Dolif R, Salsa A. Cerebral air emboli with use of central venous catheter in mobile patient. Lancet. 1991;338:1331.
Schlimp CJ, Loimer T, Rieger M, Lederer W, Schmidts MB. The Potential of Venous Air Embolism Ascending Retrograde to the Brain. Journal of forensic sciences. 2005;50(4):906-9.
Blanc P, Boussuges A, Henriette K, Sainty J, Deleflie M. Iatrogenic cerebral air embolism: importance of an early hyperbaric oxygenation. Intensive Care Medicine. 2002;28:559-63.
Walker MB. Iatrogenic arterial gas embolism in Australia - a demographic perspective. Diving and Hyperbaric Medicine. 2006;36(3):158
Trytko BE, Bennett MH. Arterial gas embolism: a review of cases at Prince of Wales Hospital, Sydney, 1996 to 2006. Anaesthesia and Intensive Care. 2008;36:60-4.
Fracasso T, Karger B, Schmidt PF, Reinbold WD, Pfeiffer H. Retrograde Venous Cerebral Air Embolism from Disconnected Central Venous Catheter: An Experimental Model. Journal of Forensic Science. 2011;56(S1):S101-S4.
Bothma PA, Brodbeck A, Smith B. Cerebral Venous Air Embolism Treated with Hyperbaric Oxygen: A Case report. Diving and Hyperbaric Medicine. 2012 June; 42(2):101-103.
Souday V, Radermacher P, Asfar P. Cerebral arterial gas embolism-a race against time! Crit Care Med. 2013 Jul;41(7):1817-9. PubMed PMID: 23774349.
Buompadre MC, Arroyo HA. Accidental cerebral venous gas embolism in a young patient with congenital heart disease. J Child Neurol. 2008;23:121-123.
Bothma PA, Heij REA. Despite animal studies, HBOT is the treatment of choice for cerebral gas embolism. Diving and Hyperbaric Medicine. December 2013;44(4)
P. A. Bothma and C. J. Schlimp. Retrograde cerebral venous gas embolism: are we missing too many cases? Br. J. Anaesth. (2014) 112 (3): 401-404 doi:10.1093/bja/aet433
Beevor, H. and G. Frawley (2016). "Iatrogenic cerebral gas embolism: analysis of the presentation, management and outcomes of patients referred to The Alfred Hospital Hyperbaric Unit." Diving Hyperb Med 46(1): 15-21.
Fakkert, R. A., et al. (2023). "Early hyperbaric oxygen therapy is associated with favorable outcome in patients with iatrogenic cerebral arterial gas embolism: systematic review and individual patient data meta-analysis of observational studies." Crit Care 27(1): 282.
BACKGROUND: Iatrogenic cerebral arterial gas embolism (CAGE) caused by invasive medical procedures may be treated with hyperbaric oxygen therapy (HBOT). Previous studies suggested that initiation of HBOT within 6-8 h is associated with higher probability of favorable outcome, when compared to time-to- HBOT beyond 8 h. We performed a group level and individual patient level meta- analysis of observational studies, to evaluate the relationship between time-to-HBOT and outcome after iatrogenic CAGE.
METHODS: We systematically searched for studies reporting on time-to-HBOT and outcome in patients with iatrogenic CAGE. On group level, we meta-analyzed the differences between median time-to-HBOT in patients with favorable versus unfavorable outcome. On individual patient level, we analyzed the relationship between time-to-HBOT and probability of favorable outcome in a generalized linear mixed effects model.
RESULTS: Group level meta- analysis (ten studies, 263 patients) shows that patients with favorable outcome were treated with HBOT 2.4 h (95% CI 0.6-9.7) earlier than patients with unfavorable outcome. The generalized linear mixed effects model (eight studies, 126 patients) shows a significant relationship between time-to-HBOT and probability of favorable outcome (p = 0.013) that remains significant after correcting for severity of manifestations (p = 0.041). Probability of favorable outcome decreases from approximately 65% when HBOT is started immediately, to 30% when HBOT is delayed for 15 h.
CONCLUSIONS: Increased time-to-HBOT is associated with decreased probability of favorable outcome in iatrogenic CAGE. This suggests that early initiation of HBOT in iatrogenic CAGE is of vital importance.
Gorman, D., et al. (1987). "Redistribution of cerebral arterial gas emboli: A comparison of treatment regimens." 9th International Symposium on Underwater and Hyperbaric Physiology Undersea and Hyperbaric Medical Sociaety, Bethesda, MD: 1031-1050.
Helps, S. C. and D. F. Gorman (1991). "Air embolism of the brain in rabbits pretreated with mechlorethamine." Stroke 22(3): 351-354.
Helps, S., et al. (1990). "The effect of gas emboli on rabbit cerebral blood flow." Stroke 21(1): 94-99.
Helps, S., et al. (1990). "Increasing doses of intracarotid air and cerebral blood flow in rabbits." Stroke 21(9): 1340-1345.
Weenink, R. P., et al. (2012). "Animal models of cerebral arterial gas embolism." J Neurosci Methods 205(2): 233-245.