Cerebral arterial gas embolism following cardiopulmonary bypass surgery.

A 13-year-old boy with a history of tetrology of Fallot underwent a pulmonary value replacement procedure. Gas bubbles were observed in the bypass circuit during the procedure. Trendelenburg position, one of the older standard recommendations when arterial gas embolism (AGE) is suspected, was established during the remainder of the procedure [1]. The patient could not support respirations adequately and remained minimally responsive following the procedure. Hyperbaric oxygen therapy was implemented to reduce gas bubble volume and facilitate diffusion of gas back into solution [2]. During the hyperbaric oxygen therapy, the patient experienced three cardiac arrests requiring chest compressions and pressor support. Following the hyperbaric procedure, the patient remained without brainstem reflexes and did not breathe spontaneously. Crepitus was present throughout the abdominal and pelvic areas. The accompanying scan (Fig. 1) was performed six hours after the hyperbaric procedure ended to confirm the diagnosis. AGE is a known complication of underwater diving using compressed air and a rare complication of medical procedures. Iatrogenic causes are more common in procedures that access the arterial circulation, such as