Treatment of cerebral air embolism in the pediatric patient.

Abstract

A 3-mo-old female with cerebral air embolism (CAE) was referred for hyperbaric oxygen (HBO) therapy. The infant, having undergone palliative closed heart surgery less than 24 h before, suffered a cardiac arrest, believed to be secondary to CAE. The infant was successfully resuscitated after a brief period of CPR, but remained neurologically depressed. The diagnosis was confirmed by computed tomography (CT) scan. The decision to treat with HBO, using U.S. Navy diving table 6A, was made with the realization that , to the best of our knowledge, this had never been attempted in the Reneau* unit on a pediatric patient who required such extensive life-support measures. The case deals with successful treatment of CAE in an infant utilizing HBO at 4.5 atmosphere absolute (ATA) pressure, and it emphasizes the problems unique to the management of extensive cardiopulmonary life-support measures during treatment. Among these measures are optimal ventilation using an adapted Babybird* ventilator and hemodynamic monitoring of arterial and central venous pressures under hyperbaric conditions. Finally, this study addresses the effectiveness of additional treatments given to treat cerebral edema as documented by return of neurologic stability and CT scan reports.