PMID- 27044457
OWN - NLM
STAT- MEDLINE
DCOM- 20160505
LR  - 20160707
IS  - 1833-3516 (Print)
IS  - 1833-3516 (Linking)
VI  - 46
IP  - 1
DP  - 2016 Mar
TI  - Iatrogenic cerebral gas embolism: analysis of the presentation, management and 
      outcomes of patients referred to The Alfred Hospital Hyperbaric Unit.
PG  - 15-21
AB  - INTRODUCTION: The aim of this study was to review patients with iatrogenic 
      cerebral gas embolism (CGE) referred to The Alfred Hospital hyperbaric unit to 
      determine whether hyperbaric oxygen treatment (HBOT) reduced morbidity and 
      mortality. METHODS: This is a retrospective cohort study with a contemporaneous 
      comparison group of patients referred between January 1998 and December 2014. The 
      primary end point was good neurological outcome at the time of discharge from 
      hospital or rehabilitation facility as assessed by the Glasgow Outcome Scale 
      (GOS-E). RESULTS: Thirty-six patients were treated with HBOT for CGE and nine 
      patients were diagnosed with CGE but did not receive HBOT. Thirty-two patients 
      developed CGE from an arterial source and 13 from a venous source. The mean time 
      from recognition of the event to institution of HBOT was 15 hours. Four of 45 
      patients (8.9%) died. Good neurological outcomes (defined as GOS-E 7 or 8) 
      occurred in 27 patients and moderate disability in 13. The only independent 
      factor that was associated with good neurological outcome was time to first HBOT 
      (OR 0.94, 0.89-0.99; P = 0.05). Hemiplegia as the first presenting sign, however, 
      was associated with poor outcome (OR 0.27, 0.06-1.08; P = 0.05). The source of 
      embolus (arterial versus venous), hyperbaric treatment table used and patient age 
      did not affect outcome. CONCLUSION: Appropriate treatment of CGE with hyperbaric 
      oxygen was found to be impeded by delays in diagnosis and subsequent transfer of 
      patients. Better neurological outcome was associated with HBOT within eight hours 
      of CGE.
FAU - Beevor, Harriet
AU  - Beevor H
AD  - Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, 
      Melbourne, Victoria, Australia.
FAU - Frawley, Geoff
AU  - Frawley G
AD  - Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, 55 
      Commercial Rd, Prahran, Victoria 3181 Australia, Phone: +61-(0)3-9076-2269, 
      E-mail: G.Frawley@alfred.org.au.
LA  - eng
PT  - Journal Article
PL  - Australia
TA  - Diving Hyperb Med
JT  - Diving and hyperbaric medicine
JID - 101282742
SB  - IM
CIN - Diving Hyperb Med. 2016 Jun;46(2):119. PMID: 27335001
CIN - Diving Hyperb Med. 2016 Jun;46(2):120. PMID: 27335002
MH  - Adult
MH  - Biophysical Phenomena/physiology
MH  - Chi-Square Distribution
MH  - Embolism, Air/etiology/mortality/*therapy
MH  - Female
MH  - Glasgow Coma Scale
MH  - Humans
MH  - *Hyperbaric Oxygenation
MH  - Iatrogenic Disease
MH  - Intracranial Embolism/etiology/mortality/*therapy
MH  - Male
MH  - Middle Aged
MH  - Regression Analysis
MH  - Retrospective Studies
MH  - Time Factors
OTO - NOTNLM
OT  - Cerebral arterial gas embolism (CAGE)
OT  - clinical audit
OT  - hyperbaric oxygen therapy
OT  - outcome
OT  - venous gas embolism
EDAT- 2016/04/06 06:00
MHDA- 2016/05/06 06:00
CRDT- 2016/04/06 06:00
PHST- 2016/02/07 00:00 [received]
PHST- 2016/02/08 00:00 [accepted]
PHST- 2016/04/06 06:00 [entrez]
PHST- 2016/04/06 06:00 [pubmed]
PHST- 2016/05/06 06:00 [medline]
PST - ppublish
SO  - Diving Hyperb Med. 2016 Mar;46(1):15-21.