DOI: 10.12890/2020_001576

Recurring Asystole and Paradoxical Air Embolization in a Patient with a Patent Foramen Ovale Treated with Home Parenteral Nutrition

Authors

  • Laura Gombošová 1st Department of Internal Medicine, University Hospital of L. Pasteur and Medical Faculty of P.J. Šafárik University, Košice, Slovakia
  • Jana Deptová 1st Department of Internal Medicine, University Hospital of L. Pasteur and Medical Faculty of P.J. Šafárik University, Košice, Slovakia
  • Juraj Podracký Cardiology Clinic, Eastern Slovak Cardiology Institute, Košice, Slovakia
  • Daniel Farkaš Institute of Forensic Medicine, University of P.J. Šafarik, Košice, Slovakia
  • Ivica Lazúrová 1st Department of Internal Medicine, University Hospital of L. Pasteur and Medical Faculty of P.J. Šafárik University, Košice, Slovakia

lauragombosova@yahoo.com

Keywords

Air embolization, patent foramen ovale

Abstract

Home parenteral nutrition is a therapeutic option for chronic intestinal failure. A tunnelled central venous catheter is commonly used for self-application of nutrition and hydration over a long period of time; that is, months or years. Air embolization within the venous circulation can be caused by inconsistent self-handling of the catheter in combination with air bubbles in the infusion set. Paradoxical air embolization within the brain and coronary arteries together with catheter perforation is a rare medical and technical complication. The authors report the case of a 63-year-old woman with type 3 chronic intestinal failure treated with home parenteral nutrition. During the first year of treatment and use of the catheter a fatal complication occurred. The patient experienced recurring asystolic episodes and strokes with monoplegia during flushing of the catheter. Although 2 resuscitations were successful, the third was not, and the patient died. The cause of these life-threatening complications was an unknown patent foramen ovale, with paradoxical air embolization within the coronary and brain arteries. The authors discuss the clinical consequences of arterial and venous air embolization, the differences between these and the therapeutic algorithm with a link to practice.

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References

  1. Santangelo G, Ielasi A, Pattarino F, Saino AT, Scopelliti PA, Tespili M. Pulmonary embolism with migrating thrombus through patent foramen ovale: a case for a mixed pharmacological and percutaneous management. J Cardiol Cases 2019;19:19–21.
  2. Yesilaras M, Atilla OD, Aksay E, Kilic TY. Retrograde cerebral air embolism. Am J Emerg Med 2014;32(12):1562.e1–1562.e2.
  3. Arcinas LA, Liu S, Schacter GI, Kass M. Cerebral air embolism following central venous catheter removal. Am J Med 2017;130(12):549–550.
  4. Rahman UZ, Murtaza G, Pourmorteza M, Minaoui WKE, Sethi P, Mamdouhi P, et al. Cardiac arrest as a consequence of air embolism: a case report and literature review. Case Rep Med 2016;2016:8236845.
  5. Balakrishnan B, Noor Z, Curran CL. Bubbles in the heart: a case of venous air thromboembolism. Resp Med Case Rep 2016;18:58–61.
  6. Malik N, Claus PL, Illman JE, Kligerman SJ, Moynagh MR, Levin DL, et al. Air embolism: diagnosis and management. Future Cardiol 2017;13(4):365–378.
  7. McCarthy CJ, Behravesh C, Naidu SG, Oklu R. Air embolism: diagnosis, clinical management and outcomes. Diagnostics 2017;7(1):5–9.

Published

2020-08-11

Issue

Vol. 7 No. 11 (2020)

How to Cite

1.
Gombošová L, Deptová J, Podracký J, Farkaš D, Lazúrová I. Recurring Asystole and Paradoxical Air Embolization in a Patient with a Patent Foramen Ovale Treated with Home Parenteral Nutrition. EJCRIM [Internet]. 2020 Aug. 11 [cited 2026 Nov. 3];7(11). Available from: https://ejcrim.com/index.php/ejcrim/article/view/1576