CPR in VAE

Q: While the nurse was pulling the central venous line, the patient took a deep breath and soon after went into a PEA arrest. There is a high suspicion of venous Air Embolism (VAE). The patient was put in bed, and CPR started. CPR serves two purposes in VAE.

Discussion: If CPR is required in venous air embolism, the patient should be placed in a head-down and left lateral position.  CPR in venous air embolism serves a dual purpose. Besides maintaining cardiac output,  CPR may also help to break large air bubbles into smaller ones. 

Literature shows that cardiac massage is as effective as putting the patient in the left lateral position and as effective as intracardiac air aspiration via a central venous catheter.

#hemodynamic

#resuscitation

References:

1. Mirski MA, Lele AV, Fitzsimmons L, Toung TJ. Diagnosis and treatment of vascular air embolism. Anesthesiology. Jan 2007;106(1):164-77.

2. Sviri S, Woods WP, van Heerden PV. Air embolism--a case series and review. Crit Care Resusc. Dec 2004;6(4):271-6.

3. Muth CM, Shank ES. Gas embolism. N Engl J Med. Feb 17 2000;342(7):476-82. 

4. Pronovost PJ, Wu AW, Sexton JB. Acute decompensation after removing a central line: practical approaches to increasing safety in the intensive care unit. Ann Intern Med. Jun 15 2004;140(12):1025-33.