Pulmonary (venous) air embolism

Pulmonary (venous) air embolism is a catastrophe which may occur under a variety of circumstances in medical practice. It must be distinguished from arterial air embolism. Our studies in the experimental animal have shown that important factors in determining whether death or survival will occur are: (1) the amount of air which gains admission to the circulation, (2) the speed with which it enters, (3) the position of the body at the time of the embolic accident, and (4) the efficacy of the respiratory excretory mechanism. Death, when it occurs, is due to circulatory obstruction resulting from an air trap in the right ventricular outflow tract. Displacement of the air trap by turning the body into the left lateral position may be life saving even after the right ventricular contractions have become feeble and death seems imminent. Pulmonary air embolism provides a valuable means of studying experimentally the effects of acute right ventricular dilatation produced by obstruction. The rapid and profound electrocardiographic changes which occur under these circumstances include an excellent demonstration of the effects of myocardial ischemia, and also, in some instances, the demonstration of right ventricular conduction defects. The observations of Bayley and LaDue concerning the ischemia-injury pattern are confirmed.