Venous air embolism in traumatic deaths

Venous air embolism (VAE) occurs when air enters the systemic venous circulation due to iatrogenic or traumatic vascular injury and may cause sudden death via acute right ventricular failure. VAE may be demonstrated post-mortem using imaging and autopsy techniques, though detection may be complicated by putrefaction, and it is likely underdiagnosed in traumatic deaths in current forensic practice due to the presence of other potentially fatal injuries. A retrospective cross-sectional study was undertaken to determine the prevalence of potential VAE (pVAE) in traumatic deaths, using data from Coronial & Public Health Sciences, QLD. 162 cases were included for analysis; pVAE was observed on post-mortem imaging in 47 (29.0%). The majority of pVAE cases involved skull fractures; chest injuries were also frequently present. A statistically significant association was identified between pVAE and age group, with prevalence highest in the 18 -35 year old group. No associations were identified between pVAE and other decedent demographics. Additionally, no associations were identified between extent of decomposition, intrahepatic gas, and intracardiac gas, indicating that pVAE cannot be definitively excluded in cases where the former two variables are observed. Further research into VAE in traumatic deaths would be beneficial to improve understanding of the phenomenon in the forensic context.