Cerebral Arterial Gas Embolism Patients Treated with Hyperbaric Oxygen at Hennepin County Medical Center Hyperbaric Oxygen Chamber from 1987-2010: Data table

# / Age / Sex / A/V / Cause of embolism / Medical comorbidities / Initial Sign and Symptoms of CAGE / Diagnostic imaging before HBO2 / Time to HBO2 / Other diagnostic tests& treatments / HBO2
sessions / Treatment table / Complication during HBO2 / Final Outcome
1 / 57 / M / V / Right CVC catheter removal / R side 15% TBSA burn,history of alcohol abuse, pancreatic CA s/p resection &esophagectomy, depression / Tachypnea, SOB, stool incontinence, right gaze preference, L sided paralysis, and complete L sided neglect. / CT head showing air in R MCA territory / 3 hrs / Myringotomy BL, intubation, IV rt-PA loading dose. Unremarkable EKG changes, negative troponins, CXR: no pneumothorax, LLL opacity consistent with atelectasis and small pleural effusion / 3 / USN Table 6 x 1 and table 5x2 / None / Improved. Completely recovered LUE motor function, LLE strength 3/5. f/u CT with evolving infarct, no air
2 / 73 / M / A / Pneumothorax related to lung biopsy 3 days prior to CAGE, colonoscopy done 1 day prior to CAGE - (air entry could be due to either of two events) / Colonoscopy 1 day back, lung biopsy with Pneumothorax 3 days back, Metastatic Rectal CA, COPD, lung nodule bx positive for CA , carotid stenosis , IDDM, HTN, CAD, previous CVAs, DVT, OSA, IBD / Unresponsiveness with decerebrate posturing, brain stem reflexes present. / CT scan showing air/infarct/ edema in R MCA territory / 13hrs 20 mins / Intubation, chest tube for recent pneumothorax, elevated troponins, EKG showing anterior wall MI. / 1 / USN Table 6 / none / Died (Diffuse brain injury). F/U head CT : massive right MCA/ACA infarct/edema & smaller amount or scattered air in R MCA distribution.
3 / 3 / F / V / Cardiac catheterization / Cardiac catheterization 2 days prior for Congenital heart disease / L hemiplegia with incontinence / CT head showing air in R MCA distribution, MRI with acute infarct in R MCA territory / 13 hrs 53 mins / ECHO showing air in R ventricle shunting to left &thrombus in IVC, CXR with left hilar infiltrate, Myringotomy BL, intubation / 2 / USN Table 6x2 / none / Died. F/U head CT Massive right MCA infarct, cerebral edema, air foci.
4 / 60 / M / A / Pulmonary overpressure accident with CAGE during HBO2 treatment for soft tissue radiation injury / Multiple HBO2 sessions for treatment of soft tissue radiation injury to mandible, emphysema. / R sided hemiplegia upon ascent during 28th treatment / Not done / 1 hrs 12 mins / None / 1 / USN Table 6 / none / Resolution.
Follow up MRI showed mild ischemia in L peri-rolandic and ant parietal lobes
5 / 50 / F / V / Self-exploration of porta-cath / DM2, pain meds abuse, hypothyroidism, hyperlipidemia / Severe right sided headache,photophobia, blurring vision / CT head showed air in L jugular vein, cavernous sinus, sup ophthalmic veins and cervicomedullary junction / ~ 13 hrs / EKG: Sinus rhythm with mild inferior ST-T wave changes / 1 / USN Table 6 / none / Resolution of vision blurriness but persistent HA. F/U head CT: no air
6 / 55 / M / V / 30-55 cc of air introduced during dialysis for ESRD / CAD s/p CABG s/p PCI, HTN, DM2, polysubstance abuse including EtOH / LOC during dialysis for ESRD,Chest pain,dyspnea, nausea, headache, R sided focal weakness with paresthesia in R leg / CT head with no air in vasculature / 3 hrs / ASA, NTG, Bedside ECHO likely ASD,EKG:LVH and non-diagnostic ST segment changes, CXR: chronic L pleural effusion and apparent atelectasis, bilateral myringotomy / 1 / USN Table 6 / none / Resolution of symptoms and neurologic deficits. F/U head CT infarct left frontal lobe
7 / 56 / M / A / Percutaneous closure of ASD / ASD, NIDDM, OSA, HTN / LUE paralysis and L facial droop and LLE weakness and confusion, altered mental status / CT head with air embolus in right frontal lobe / 4hrs 48 mins / EKG:sinus tachycardia with no ST elevations. / 1 / USN Table 6 / none / Improved. Follow up CT head showing small R anterior frontal infarct with no residual air.
8 / 53 / M / A / Cardiac ablation procedure for Chronic Afib / Chronic afib, TBI w/ L sided weakness, seizure disorder / Confusion, hypotension,bradycardia, chest and back pain w/ third deg heart block / None / 10 hrs 10 mins / Cardiac angiographyshowed occluded LAD with air in L ventricle. TTE – LAE, mod TR, elevated trops, ST elevation. CXR: bibasilar atelectasis with no infiltrates. / 1 / USN Table 6 / none / Resolution
9 / 72 / M / V / Hickman catheter disconnected / HTN, Diabetes s/p laser for retinopathy, COPD and CRF / AMS, acute bilateral blindness,subjective weakness, SOB,hypotension, hypoxemia / CT head – right occipital infarct / Unknown but likely less than 12 hrs / CXR: air in pulmonary artery and right ventricle,pulmonary edema, EKG: peaked T-waves, left ant fascicular block, potassium was 6, elevated troponins / 1 / USN Table 6 aborted d/t seizures and respiratory distress / Two seizure episodes during HBO2 treatment with headache / Unchanged. F/u MRI right occipital infarct.EEG: R posterior quadrant epileptogenicity. DNR/DNI >hospice care
10 / 53 / M / V / cardiac radioablation / CADwith coronary artery stents, atrial fib/ flutter, SVT / Severe L facial droop, left visual field cut with slurred speech / CT head with air in cerebral vasculature (R MCA dist) / Likely ~ 12 hrs / Heparin,Myringotomy BL, EKG: long QT, PVCs and BBB / 1 / USN Table 6 with ext at 60ft and 30ft / none / Improved.Follow up CT with infarct in R MCA territory.
11 / 66 / M / A / Carotid and Innominate stenting / CAD, large vessel atherosclerotic dis, COPD, obesity, dyslipidemia, / Left sided facial, arm and leg paralysis, right gaze preference / CT head with gas embolism in the brain. / 4-6 hrs / Intra-arterial rt-PA prior to diagnosis of CAGE, followed by CT head showing gas embolism ,intubation, sedation, myringotomy, EKG: new lateral ST depression / 1 / USN Table 6, aborted due to Cushing's reflex. / Brady-asystolic event, declining neurological status / Died. F/U head CT with massive R basal ganglia ICH with edema & midline shift, loss of brain stem reflexes > Comfort care.
12 / 41 / F / A / Lung biopsy / spindle cell CA, R hip and leg amputation, / AMS, not moving extremities / Head CT wit BL cerebellar and pontine infarcts thought to be metastatic emboli initially, no air seen / > 30 hrs / Cardiac ECHO:decreased EF, elevated trops 7.4, CK 778, EKG: sinus tach, anterolateral T wave changes. CXR:left lower lobe atelectasis. Myringotomies / 1 / USN Table Table 6 / none / Unchanged.Bilat cerebellar and pons infarcts on f/u MRI
13 / 41 / F / V / CVC removal / ESRD s/p renal transplant, HTN, cholecysectomy / Seizures, coma(GCS 4-5, responding to pain) / CT head: normal, MRA: normal / 3.5hrs / Cardiac ECHO showing ASD w/ R-->L shunt. Elevated trops, lactate, CK. EKG: non-specific ST-T changes, CXR: normal / 1 / USN Table 6 – aborted due to seizures / Continued seizures during HBO2 / Improved.
14 / 86 / F / A / Aortic valve replacement / CAD, CHF, severe AS, Afib, COPD / Seizures after anesthesia wore off, unresponsiveness / CT head with diffusely low attenuation, no air / 28hrs / EKG:sinus rhythm, poor R wave progression, lateral ST depression, CXR: hilar congestion, Swan-ganz catheter and three chest tubes, myringotomy BL / 2 / Table 6, Table 5 / Continued to seize sometimes during HBO2 / Unchanged
15 / 40 / F / V / CVC cap off / s/p ventral hernia repair withileus, IBS, migraine, malnutrition / Sudden right hemiparesis, numbness, headache, and aphasia when she sat up / CT head: normal / 6.5hrs / CXR: normal,myringotomy, EKG: normal / 1 / USN Table 6 / None / Improved
16 / 17 / F / V / CVC removal / Guillain-Barre syndrome w/ neurological motor deficits in BL LE 3/5 strength, also decreased sensation / Sudden hypotension, tachycardia, hypoxia, chest pain, seizure / Not done / 5.25hrs / CXR vascular congestion, ABG – hypoxia, EKG w/ sinus tachy. Cardiac ECHO showed no air, EKG w/ sinus tachy / 1 / USN Table6A / Bilat pleural effusion, SOB / Improved
17 / 70 / F / V / Abdominal insufflation after resection of lung cancer / Lung cancer, COPD, HTN, PFO / Acute hypotension (SBP 70 mmHg), coma / CT head: 2 hrs after event showing small foci of air in post parasagittal left frontal lobe / 7 hrs / CXR: air under diaphragm, subcutaneous emphysema. Normal trops, CK 836, EKG: inverted T waves. Two chest tubes, Myringotomy BL. / 1 / USN Table 6 / none / Died. Withdrawal of care on day 2. MRI day after admission: bi-hemispheric infarcts.
18 / 49 / F / V / CV catheter leak / ESRD, IDDM, CABG, Gastroparesis CVA, CHF with pulm edema hypothyroid, migraine HA / Day 1: CP, trop 1.1. Day 3: CP, nausea, SOB, R neck and jaw pain, R parietal HA . Day 4 R neck and jaw pain ,confusion, anxiety HA, stiff LUE, new cardiac rub. Day 5 sudden deterioration, worse CP SOB irritability, somnolent, LUE weakness / CT head: air, multiple small infarcts.
HCT 2 days prior: normal.
MRI 2 days prior: multiple bilateral infarcts. / 5days / TTE: air in RV, no shunt, dec LV Fxn, inf LVWMA. EKG: Q wave inferirorleads,,LVH. CXR:mild cardiac, pulm edema. TEE - no air, no shunt poss AV malformMyringotomy BL, / 1 / USN Table6A / fever 103.4 / Improved. Speech and motor activity on R arm/leg improved, Dec spasticity on Left
19 / 38 / F / V / R Internal jugular catheter accidentally came out in clinic / Arthritis, Lupus, central line for chemotherapy / Abrupt Loss of Consciousness, decrease mental status, dizziness. Progressing ARDS, disorientation fluctuating mental status / CT head: normal / 28 hrs / LP normal, CXR - BL infiltrates, Echo: normal, no air.Chest CT – diffuse BL infiltrateswith pulm edema. EKG: sinus tachy. Intubated. / 1 / USN Table6 / none / Resolved
20 / 42 / M / V / Subclavian CVC line removed / HIV, pancreatitis with sepsis / Cardiopulmonary arrest s/p CPR sedated and paralyzed. Seizures after resuscitation, GCS 3 / CT head: normal / 10.75 hrs / Chest CT/ Angio: normal.EKG: sinus tachy perihilar infiltrates, pulm edema / 1 / USN Table6 / none / Unchanged. Anoxic brain Injury, DNR/DNI to nursing home
21 / 42 / M / V / End of dialysis quinton fell off, when rolled over in bed catheter noted bleeding. / ESRD on dialysis, AIDS, HTN / Heard woosh of air, felt dizzy R sided heaviness, decreased R arm movement, R leg heavy weak, R lower facial weakness &"numbness" speech disturbance. / Not done / 6 hrs / EKG: NSR, LVH. CXR interstitial pulm edema, cardiomegaly. EEG: normal / 1 / USN Table 6 / none / Resolved
22 / 56 / M / V / HBO2 Rx for osteoradionecrosis 16th treatment during ascent / s/p tongue CA resection radical neck dissection, pulmmets, partial pneumonectomy / Weakness R arm and leg without neglect / Not done / 0 - immed / N/A / 1 / USN Table 6 / none / Resolved
23 / 17 / M / V / L Subclavian CVC line removal. Patient coughed during removal / Ulcerative Colitis, Migraine HA / Sudden SOB, near syncope during CXR, questionable seizure activity, obtundation, decreased vision / CT head: with airin cerebral vasculature / ~ 4.45 hrs / EKG: incr voltage. CXR: interstitial changes / 1 / USN Table 6 / none / Resolved. F/U head CT no air or infarct
24 / 73 / M / V / Patient heard air rush into neck when SwanGanz removed, cordis left in place / GI Bleed, aortojejunal fistula, AAA, CABG / Reduced level of consciousness , obtunded, posturing / CT head: no acute infarct or air / ~ 9hrs / Cardiac Echo: air in BL A+V. Loud cardiac murmur. CXR - no free air cordis removed, repeat echo - no air. EKG: sinus tachy, LVH CXR: BL infiltrates, pulm edema, intubated, a-line radial cutdown / 1 / USN Table 6 / Unstable BP / Resolved.
25 / 80 / F / V / Dialysis tubing disconnected while on dialysis. Venous line of Quinton / ESRD on dialysis. Afib DM, Hyperkalemia, Dementia, Breast CA / Respiratory then cardiac arrest,resuscitated to afibwith rapid vent response, eyes open, unresponsive, no spontaneous movement absent pupillary and corneal reflexes, +gag, triple flexion. / Not done / ~ 5 hrs / CXR: BL pleural effusion, R interstitial pattern pulm edema. Intubated / 1 / USN Table 6 / none / Unchanged. Family withdrew support & pt passed away two weeks later due to worsening from probable aspiration pneumonia and septicemia. F/U imaging diffuse edema/ bilateralinfarct.
26 / 67 / F / V / CT guided transthoracic needle biopsy of pulm mass / Pulmonary mass / Confusion becoming more obtunded, R decorticate posturing, R Babinski, L gaze preference, dysarthria / MRI brain: negative for bleed or air / 22 hrs / EEG diffuse delta activity in L, EKG: NSR, CXR: focal LLL edema vs. atelectasis / 1 / USN Table 6 / none / Improved
27 / 7 / F / A / Repair ASD, cardiac bypass, ventilator malfunction allowed air into arterial system via ASD / Cardiomegaly from ASD / Not awakening from anesthesia, GCS 3 / CT head: attenuation on theR parietal area, no air. / 3.25 hrs / 1 / USN Table 6a / none / Improved
28 / 81 / M / V / CT guided biopsy of pulmonary mass / Prostate CA, Colon CA, Pulm Fibrosis, CAD, AS porcine aortic valve replacement / Became deeply unresponsive during procedure, GCS 3, Seizure / CT head: air in cerebral circulation / ~4.5 hrs / EKG: NSR, CXR: small rightpneumothorax. R chest tube / 1 / USN Table 6a / Status epilepticus during HBO2 (no response to dilantin & phenobarbital) / Improved. Family withdrew care later on and died. F/u CT diffuse cerebral edema, loss of sulci.
29 / 26 / F / A / Catheter placement in R femoral artery for L carotid injection / Recalcitrant epilepsy / First inappropriate giggling,R hemiparesis (facial and RUE), aphasia, R sided neglect, seizures for 90 seconds. / Not done / 5.5 hrs / EKG: NSR / 1 / USN Table 6 / None / Resolved
30 / 48 / F / V / Mitral Valve Plasty / CRF. Mitral Stenosis, Aortic valve Insufficiency / Arrested, bypass, aortic balloon pump, GCS 3, Ventricular tachy x 2 in ED. / Not done / ~ 8 hrs / Cardiac Echo: Large air in L CVC, air in R ventricle shunting to L through septal defect. Chest tube.Myringotomy / 1 / USN Table 6a / balloon pump stopped at 60' patient tolerated, no consequences / Unchanged. Withdrawal of support and passed away
31 / 24 / F / A / Leftinternal carotid Injection / WADA Study Intractable Seizure Disorder / Depressed mental status, dysarthria, R sided weakness > 20 min. / CT head: no abnormality, no air / 6.25 hrs / Myringotomies / 1 / USN Table 6a / Sinus squeeze / Improved. MRI L middle temp lobe abnormality (old), No infact/edema
32 / 34 / F / A / L common carotid angiogram,10cc air injected / Neck laceration zone, needing carotid angiogram / Decreased mental status, not responding to voice or sternal rub, pupils reactive, withdraws to pain all extremities,RUE toes up / Not done / 1.5 hrs / EKG: diff ST-T depression, sinus tachy, no infiltrates / 1 / USN Table 6a / Status epilepticus during HBO2 for about 2hrs. Seizures due to illness did not stop with air break / Improved. Aphasic, slow speech, R hemiparesis, ambulates independently, lives at home with health aide
33 / 43 / F / V / Open heart surgery for removal of infected right atrial thrombus. Air introduced into R ventricle, found in LV. Surgery proven PFO / Sepsis due to positive blood cult Staph epidemidis from long term indwelling Hickman catheter / Did not recover normal mental statusafter surgery. Obtunded, not following commands. Pupils reactive, DTR intact, Clonus lower extremities, / Not done / ~ 6 hrs / Air aspirated at time of surgeryfrom both ventricles. EKG: NSR, ST elevation inferior and lateral. BL chest tubes. CXR: no infiltrates or effusion. / 1 / USN Table 6a / None / Improved. At d/c answering questions sometimes inappropriate, follows commands, not speaking spont, LEs > UEs spont extremity movement.F/U head CT: no acute changes
34 / 50 / F / A / Mitral Valve Replacement air introduced canalizing aorta / MV replacement 1981, TIA's / Decerebrate- decorticate posturing, pupils fixed/dilated, deep coma, improving over 24 hrstospont moving all extr and openingeyes.Hyper-reflexic, sustained clonus, BL Babinski. / CT head: no abnormality / 30 hrs / CXR: no infiltrate, cardiac ECHO: NSR, EEG improving response,deep coma. Intubated, BL chest tubes placed, CVC line / 1 / USN Table
6A extended by USN Table 4 / Post HBO2consolidation in LLL, progressed and prevented further HBO2(O2toxicity) / Improved. F/U CT with cerebral edema consistent with past air embolism.
35 / 49 / M / V / Patient cut subclavian CVC / ICH, left hosp. AMA w/ CVP line / Acute SOB, dyspnea, tachycardia, confusion / CT head: ICH improving, no air / ~ 4.5 hrs / Intubated, ventilator L CV line, R removed increase pulm edema NSR / 1 / 6a / None / Improved
36 / 25 / F / V / Hickman catheter split / Idiopathic dysautonomia, TPN / Chest pain, SOB, headache when stood up.Noted wetness and bubbling from Hickman site, split in it, was playing with dog. / CT head : normal / ~ 5.5 hrs / EKG: diffuse T wave inversions / 1 / USN Table 6a / L side decreased pin prick and light touch and mild motor weakness / Resolved. F/U head CT no change.

Abbreviations used: #= number, CAGE = cerebral arterial gas embolism, A/V= arterial/venous, CVC= central venous catheter, HBO2 = hyperbaric oxygen, F/U =follow up, TBSA=total body surface area, s/p=status post, rt-PA= recombinant tissue plasminogen activator, CXR: chest x-ray, LLL= left lower lobe, CAGE= cerebral arterial gas embolism, CA= cancer, MCA=middle cerebral artery, BL=bilateral, CAD= coronary artery disease, CABG= coronary artery bypass graft, PCI=percutaneous coronary intervention, EtOH= alcohol, LOC=loss of consciousness, ESRD= end stage renal disease, Afib= atrial fibrillation, TBI=traumatic brain injury, AMS=altered mental status, ICH=intracerebral hemorrhage,CRF= chronic renal failure, ASD= atrial septal defect, USN= United States Navy.