P94 | Air embolism after central venous catheter removal in chronic obstructive pulmonary disease with patent foramen ovale

Case report: A 60 year old man came to Emergency department for dyspnoea and desaturation. In the medical history: heavy smoker (80 pack/years), chronic obstructive pulmonary disease, recent pneumonia. Severe respiratory failure was documented, a trial of NIV was started but unsuccessfully and the patient underwent endotracheal intubation and was transferred to ICU where was treated with antibiotic, steroid and bronchodilator therapy and markedly improved. After few days was extubated and transferred to the General Medicine Ward. In accordance with the good condition of the patient promptly urinary tract catheter and central venous catheter (CVC) were removed. Unfortunately the patient suddenly presented loss of consciousness with right gaze deviation and left emiparalysis strongly suspicious of cerebral ischemia. Due to the worsening of respiratory failure the patient underwent a new endotracheal intubation and then a head CT scan which documented right brain air embolism with ischemia confirmed later by magnetic resonance. Head Angio CT scan did not show any occlusion of the main brain arteries. To confirm the suspicious of air embolism due to the removal of the jugular CVC an echocardiogram was performed which documented a patent foramen ovale with right to left shunt during Valsalva manoeuvre. Conclusions: Air embolism after removal of CVC is a rare but possible complication which can have severe consequences. Several well defined precautions must be taken in account before CVC removal.