CORONARY AIR-EMBOLISM - INCIDENCE, SEVERITY, AND SUGGESTED APPROACHESTO TREATMENT - COMMENT

Because no well-controlled study of inadvertent coronary air embolism has been done to truly quantify the incidence of this cardiac catheter ization complication, we wanted to determine its incidence and severit y in an active teaching medical center and assess approaches to treatm ent. We retrospectively reviewed 3,715 coronary angiogram and PTCA rep orts performed over 32 months. Further, we classified severity based o n angiographic findings and symptoms as minimal, mild, moderate, and m assive. Two independent angiographers reviewed 764 consecutive cines p erformed in the first 2 months of training of each new fellow and 740 cines performed in the last 2 months of training. We found that during the first 2 months of training the overall incidence for significant intracoronary air embolism was 0.19% (7 documented cases) compared wit h 0.2% (3 cases) for non-reported, minimal asymptomatic air embolism. The estimated incidence for total air emboli events was 0.27% (10/3,71 5). We did not find coronary air emboli in the 740 cines performed at the end of fellowship training. Additionally, the incidence of coronar y air emboli during PTCA training was much higher compared with corona ry angiography training (0.84 vs. 0.24%). Although there is no best te chnique to restore blood flow after blockage by air emboli, we suggest as options aspirating the air or forcefully injecting saline, with au xiliary supportive measures like 100% oxygen, IABP, CPR, and DC cardio version. (C) 1995 Wiley-Liss, Inc.