Combined Trendelenburg and right lateral decubitus positioning, alongside mechanical chest compressions, contributed to successful resuscitation of a patient with left ventricular air embolism.
Case Report (n=1)
Left ventricular air embolism during percutaneous lung biopsy can cause cardiac arrest, which may be successfully managed with right lateral decubitus and Trendelenburg positioning alongside mechanical chest compressions.
Abstract Background Left ventricular air embolism is a rare yet potentially fatal complication of percutaneous lung needle biopsies. Cardiac arrest can occur when air enters the pulmonary veins and obstructs forward blood flow through the left ventricle. Evidence-based resuscitation strategies in these critical scenarios remain limited, and this case illustrates how integration of strategic positioning and assistive devices contributed to successful resuscitation. Case Presentation A 78-year-old man underwent an elective computed tomographic (CT)-guided biopsy of a left upper lobe lung nodule. A 19-gauge needle was guided to the 1.5 cm lesion with the patient in the supine position. After core biopsy was obtained, he complained of sudden-onset chest pain followed by unresponsiveness and loss of palpable pulses. Cardiopulmonary resuscitation was initiated following Advanced Cardiac Life Support (ACLS) guidelines. Intraprocedural CT imaging was reviewed and revealed an air embolism in the left ventricular apex. There was no evidence of air in the right heart or pulmonary circulation. The patient was placed in a combined Trendelenburg and right lateral decubitus position using hospital bed wedges, while compressions were delivered via a mechanical chest compression device. He was intubated and ventilated with 100% FiO2. Hyperbaric oxygen facilities were unavailable. He was resuscitated with interval resolution of intracardiac air and discharged three weeks later. Discussion Prompt recognition and timely application of resuscitation strategies are critical for survival following the rare and likely underrecognized complication of left ventricular air embolism after percutaneous lung biopsy. Positional management differs depending on whether air is in the left versus right ventricle - left ventricular air embolism may be best managed with right lateral decubitus and Trendelenburg positioning to displace air from the left ventricular outflow tract, whereas right ventricular air embolism typically requires Durant’s maneuver (left lateral decubitus with Trendelenburg) to prevent air from entering the pulmonary circulation. An automatic mechanical compression device, alongside hospital bed wedges for patient positioning, can help minimize interruptions in chest compressions during ACLS and support restoration of circulation. This abstract is funded by: None
Massion et al. (Fri,) conducted a case report in Left ventricular air embolism and cardiac arrest (n=1). Combined Trendelenburg and right lateral decubitus positioning with mechanical chest compressions was evaluated on Resuscitation and resolution of intracardiac air. Combined Trendelenburg and right lateral decubitus positioning, alongside mechanical chest compressions, contributed to successful resuscitation of a patient with left ventricular air embolism.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: