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Arterial gas embolism
Last reviewed: 07.07.2025
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Arterial gas embolism is a potentially catastrophic event that occurs when gas bubbles enter or form within the arterial system and occlude vessels, causing organ ischemia. Arterial gas embolism can cause CNS damage with rapid loss of consciousness and other neurologic deficits. Ischemia of other organs is also possible. The diagnosis, based on clinical findings, can be confirmed by imaging studies. Treatment consists of immediate recompression.
Gas emboli may enter the arterial circulation from ruptured alveoli after pulmonary barotrauma, form within an arterial vessel directly in severe decompression sickness, or migrate from the venous circulation (venous gas embolism), either through a right-to-left shunt (patent foramen ovale, atrial septal defect), or when the filtration capacity of the lungs is exceeded. Venous gas embolism, without gas entering the arterial system, is less dangerous. Although the most serious manifestation is considered to be embolism of the cerebral vessels, arterial gas embolism can cause significant ischemia in other organs (e.g., spinal cord, heart, skin, kidneys, spleen, gastrointestinal tract).
[ Symptoms of Arterial Gas Embolism
Symptoms develop within minutes of surfacing and may include altered consciousness, hemiparesis, motor or sensory deficits, seizures, loss of consciousness, respiratory arrest, and shock; death may occur. Symptoms of pulmonary barotrauma or type II decompression sickness may also occur.
Other symptoms may result from arterial gas embolism of the coronary arteries (eg, arrhythmia, MI, cardiac arrest), skin (cyanotic mottling, focal pallor of the tongue), or kidneys (hematuria, proteinuria, renal failure).
Diagnosis of arterial gas embolism
The diagnosis is based primarily on clinical findings, with a high probability if the diver loses consciousness during or immediately after surfacing. Confirming the diagnosis is difficult because air may be reabsorbed from the damaged artery before imaging. However, imaging studies that may help confirm the diagnosis include echocardiography (shows air in the ventricles of the heart), ventilation/perfusion scanning (shows changes due to pulmonary embolism), chest CT angiography (shows air in the pulmonary veins), and head CT (shows intraparenchymal gas and diffuse edema). Decompression sickness sometimes presents with similar symptoms.
Treatment of arterial gas embolism
If gas embolism is suspected, the diver should be recompressed as quickly as possible. Transport to a recompression chamber has absolute priority over all other measures. Air transport may be justified only if it saves significant time, but exposure to low pressure at altitude should be minimized.
Before transport, 100% O2 is given at high flow, washing out N, increasing the N pressure gradient between the lungs and the bloodstream, which accelerates the reabsorption of emboli. Patients should be in the supine position.
Artificial ventilation of the lungs, administration of vasoconstrictor drugs and resuscitation measures are carried out as necessary. The patient's position lying on the left side or in the Trendelenburg position is no longer required.