Air or Gas Embolism
Air or gas embolism occurs when gas bubbles enter arteries, veins and/or capillaries. This results in reduced blood flow and poor oxygen delivery to the areas supplied by the affected circulation. If not fatal, gas embolism can result in severe, long-standing and irreversible physical and emotional disabilities. There can be weakness or paralysis in the limbs; vision can be impaired or absent; brain, heart, lung and other organ damage may occur. Limited use of remaining functions can be sufficiently severe that total disability results. Those who do not die may be limited to walking with canes, crutches or walkers. Those more severely disabled may be wheelchair confined or bedridden. These outcomes may be permanent and may severely impact quality of life.
Maximal medical treatment of the condition is necessary to ensure the best possible degree of recovery from this potentially disastrous problem. Hyperbaric oxygen has been shown to reduce the size of bubbles obstructing circulation. The increased pressure in the hyperbaric chamber reduces bubble size and drives the remaining gas into physical solution, while the high oxygen pressure washes out inert gas from the bubble. When bubbles are smaller or resolved, blood flow resumes. Poorly oxygenated tissues then receive higher levels of oxygen delivery.
Another problem in gas embolism is that vessels obstructed by bubbles may leak fluid into surrounding tissues, resulting in swelling. Such swelling can further reduce tissue blood flow. When flow is restored, the local swelling will subside with resultant improvement in circulation and oxygen supply. Finally, the high levels of oxygen provided in the hyperbaric chamber have the potential to immediately restore cellular oxygen levels while blood flow impairment and tissue swelling are being corrected.
Hyperbaric oxygen treatment is the primary treatment for gas embolism and a major review of reported cases clearly indicates superior outcomes with its use compared to non-recompression treatment.
- Mushkat Y, Luxman D, Nachum Z, David MP, Melamed Y. Gas embolism complicating obstetric or gynecologic procedures. Case reports and review of the literature. European Journal of Obstetrics, Gynecology, & Reproductive Biology 1995;63:97-103.
- Boussuges A, Blanc P, Molenat F, Bergmann E, Sainty JM. Prognosis in iatrogenic gas embolism. Minerva Medica 1995;86:453-457.
- Weiss LD, Van Meter KW. The applications of hyperbaric oxygen therapy in emergency medicine. American Journal of Emergency Medicine 1992;10:558-568.
- Kindwall EP. Uses of hyperbaric oxygen therapy in the 1990s. Cleveland Clinic Journal of Medicine. 1992;59:517-528.
- Dutka AJ. Air or gas embolism. In: Hyperbaric Oxygen Therapy: A Critical Review. Camporesi EM, Barker AC, eds. Bethesda, MD, Undersea and Hyperbaric Medical Society, 1991:1-10.