Successful treatment of intracardiac air embolism using intracardiac catheter aspiration

Intracardic air embolism is uncommon, however it is a serious condition which frequently leads to catastrophic complications during or after invasive procedures resulting in significant morbidity and mortality. For a successful resuscitation of patients with intracardiac air embolism, hyperbaric oxygen therapy is critical. Still, due to a hyperbaric chamber’s unavailability at many hospitals and concerns about patient movement resulting in further embolism during transport, such treatment method is gradually diminishing. We present a case of acute-onset right-sided heart failure from massive intracardiac air embolism that was successfully treated with an intracardiac catheter aspiration procedure instead of hyperbaric oxygen therapy.  A 78-year old man with a history of hypertension, diabetes mellitus, and ischemic heart disease presented to the emergency department with dyspnea (NYHA FC III-IV) and chest discomfort. The patient had been complaining of coughs and sputum over the past week. In the morning of admission day, he had got an intramuscular injection at the hip. He had undergone coronary artery bypass graft three years ago and had been well until this present admission. ECG and chest X-ray were normal with no widening of the mediastinum or pleural effusion observed, and blood chemistry was also normal except for the high brain natriuretic peptide (BNP) level [952 (0–100 pg/mL)]. Transthoracic echocardiography (TTE) showed severe diastolic dysfunction and pulmonary hypertension with inferior vena cava (IVC) plethora. A chest CT was done, which revealed a large amount of air in the right atrium, right ventricle, and pulmonary artery (Figure 1A–1B). In addition, there were air bubbles in brachiocephalic veins, left subclavian and axillary vein, right internal jugular vein, and the pre-thyroid