[abstract] HBO2 FOR THE TREATMENT OF INTRAVASCULAR CO2 EMBOLISM

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[abstract] HBO2 FOR THE TREATMENT OF INTRAVASCULAR CO2 EMBOLISM

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Title: [abstract] HBO2 FOR THE TREATMENT OF INTRAVASCULAR CO2 EMBOLISM
Author: Gorji, R; McGinn-Merritt, WL; Bush, C; Camporesi, EM
Abstract: INTRODUCTION: Patients with contrast dye allergies pose a challenge to clinicians. Intravascular CO2 as a contrast agent in radiological studies is a cost effective, safe, and easily administered alternative. Arterial gas embolism is a rare complication of CO2 intravascular injection due to high solubility in blood and tissues. CASE REPORT: A 79 year old female with a history of end stage renal disease (ESRD) and contrast dye allergy developed a sudden onset of headache 3-4 seconds following an injection of 20 cc of CO2 during a fistulogram in the arm. The headache resolved in a few minutes however thirty minutes following the injection she developed progressive aphasia, right upper extremity weakness, visual disturbances and hypertension (B/P 240/140). CT scan 2 hours after the event was negative. The patient received hyperbaric oxygen at 3.0 ATA for 90 minutes, four hours after the event. Subsequent electroencephalogram confirmed focal slowing. MRI, third day post incident, revealed multiple cortical/ subcortical infarction areas in both hemispheres. Following hyperbaric treatment, the patient improved clinically, and upon discharge from the hospital neurologic status was intact. DISCUSSION: Injection of CO2 is useful in ESRD patients as there is no nephrotoxicity and it's not an allergenic substance. Reported complications of CO2 injection include cardiopulmonary collapse during laparoscopic surgery (CO2 emboli), potential CO2 "neurotoxicity", and paradoxical embolism in patients with patent foramen ovale. The patient's presentation suggest arterial gas embolism of CO2 injectate. Contamination with air cannot be excluded. CONCLUSION: CO2 arteriography is a safe technique for visualization of vasculature below the diaphragm in patients with iodinated dye allergies. Hyperbaric oxygen therapy can be used safely in patients with CO2 embolism.
Description: Undersea and Hyperbaric Medical Society, Inc. (http://www.uhms.org )
URI: http://archive.rubicon-foundation.org/991
Date: 2001

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  • UHMS Meeting Abstracts
    This is a collection of the published abstracts from the Undersea and Hyperbaric Medical Society (UHMS) annual meetings.

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