Air embolism after CT-guided transthoracic interventional operation: is it necessary to change the patient's position to prevent embolized air from entering the systemic circulation.

OBJECTIVES

To investigate the influence of the patient's position on the entry of embolized air into the systemic circulation after air embolism (AE).

METHODS

116 patients with AE were selected as study subjects, including 81 patients undergoing CT-guided transthoracic biopsy and 35 patients undergoing CT-guided localization of pulmonary nodule before video-assisted thoracoscopic surgery. While maintaining the patient's original position, 94 out of 116 patients underwent at least one follow-up CT within 5-15 min after AE. The following two situations were considered as embolized air entering into systemic circulation: (1) CT showed air in the aorta and/or branches; (2) follow-up CT showed a decrease or disappearance of air in the left heart.

RESULTS

The positions of the 116 patients with AE included 6 in supine position (SP), 70 in prone position (PP), 20 in left lateral decubitus position (LLDP), and 20 in right lateral decubitus position (RLDP). Embolized air entering the systemic circulation occurred in 33.3% (2/6) patients in SP, 47.1% (33/70) patients in PP, 70% (14/20) patients in LLDP, and 55% (11/20) patients in RLDP. The difference is not statistically significant (χ2 = 4.16, P = .24).

CONCLUSIONS

The proportion of embolized air entering the systemic circulation is similar among patients in SP, PP, LLDP, and RLDP within 5-15 min after AE. The above 4 positions cannot effectively prevent the embolized air from entering the systemic circulation.

ADVANCES IN KNOWLEDGE

Embolized air enters the systemic circulation within a few minutes in about half of patients with AE. Within 5-15 min after AE, the proportion of embolized air entering the systemic circulation is similar among patients in SP, PP, LLDP, and RLDP. Changing the patient's position after AE cannot prevent embolized air from entering the systemic circulation.