Out-of-hospital cardiac arrest from air embolism during sexual intercourse: Case report and review of the literature

Summary We report the successful resuscitation of a 38-year-old woman in cardiac arrest following heterosexual intercourse 7 days after spontaneous abortion and an instrumental uterine evacuation. The collapse was thought to be due to venous air embolism (VAE). Her survival neurologically intact was attributed to appropriate first aid, pre-hospital and subsequent hospital intensive care. Neither a case of an out-of-hospital air embolism where the patient made a good recovery, nor a case of miscarriage followed by collapse from air embolism has been reported in the literature. Air embolism is a very infrequent cause of out-of-hospital cardiac arrest with a high mortality rate. Predominant causal reasons are severe penetrating neck or thoracic injuries and sexual activities in pregnancy, when air can pass into the damaged veins in the wall of the uterus and lead to total obstruction in the heart. Diagnostics and management techniques for venous air embolism are discussed. Air embolism should be included in the differential diagnosis for all young women in cardiac arrest, particularly when occuring during sexual activity. Instructions in risks of sexual intercourse during pregnancy and the puerperium should become part of pregnant women's education.