Abstract 3199: Factors Associated with Favorable Response to Hyperbaric Oxygen Therapy among Patients Presenting with Iatrogenic Cerebral Arterial Gas Embolism
Background: Iatrogenic cerebral arterial gas embolism (CAGE) is an uncommon but potentially fatal condition. Hyperbaric oxygen (HBO2) treatment is the only first line treatment for patients with CAGE presenting with acute neurological deficits.
Methods: We reviewed medical records and neuroimaging of consecutive CAGE patients treated with HBO2 at a state referral hyperbaric facility over a 22 year period. We analyzed the effect of demographics, source of intra-arterial gas, signs and symptoms, results of imaging studies, time between insult and HBO2 treatment, and response to HBO2 treatment in 36 consecutive patients. Favorable outcome was defined by complete resolution or improvement of CAGE signs and symptoms. Unfavorable outcome was defined by unchanged or worsened neurologic signs and symptoms or in hospital death.
Results: A total of 26 (72%) of the 36 patients had favorable outcome. Patients with favorable outcome were younger compared to those with unfavorable outcome (mean age [years, SD] 44.7± 17.8 vs. 58.1 ± 24.1, p-value=0.08). Time-to-HBO2 ≤ 6 hours was significantly associated with favorable outcome compared ≥ 6 hrs (p-value = 0.025). Cardiopulmonary symptoms associated with CAGE were significantly more common in venous source of gas compared to arterial (p-value = 0.024) but did not influence the rate of favorable outcomes. Two of 36 patients were treated with thrombolytics due to acute focal deficits and suspected ischemia - one with intravenous and the second one with intra-arterial thrombolysis. The later patient developed fatal intracerebral hemorrhage.
Conclusions: A high proportion of CAGE patients treated with HBO2 had favorable outcomes. Young age and time-to-HBO2 ≤ 6 hours were associated with higher rate of favorable outcome. Timely diagnosis and differentiation from thrombo-embolic ischemic events is an important determinant of successful HBO2 treatment.
- © 2012 by American Heart Association, Inc.