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Management of potential gas embolus during closure of an atrial septal defect in a three-year-old

Department of Pediatric and Congenital Cardiac Surgery, Arkansas Children’s Hospital and the College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA, johnsonce{at}archildrens.org

Sherry C Faulkner

Department of Pediatric and Congenital Cardiac Surgery, Arkansas Children’s Hospital and the College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA

Michael L Schmitz

Pediatric Cardiovascular Anesthesiology, Arkansas Children’s Hospital and the College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA

Jonathan J Drummond-Webb

Department of Pediatric and Congenital Cardiac Surgery, Arkansas Children’s Hospital and the College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA

Gas embolism occurring in adult patients supported with cardiopulmonary bypass is usually associated with mechanical complications. Management of gas embolism is less often described for the pediatric or neonatal patient. Measures to counteract gas embolism must be undertaken immediately if a satisfactory outcome is to be achieved. Here, the management of a three-year-old female patient, who was undergoing repair of a secundum atrial septal defect when the aortic cannula became dislodged and air entered the aorta, is described. Immediate implementation of an air embolism protocol, including (among other maneuvers) removal of air from the circuit, retrograde cerebral perfusion via the superior vena cava, and induction of cerebral hypothermia, may have aided in an acceptable outcome.

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