Delayed presentation of air embolism after removal of central venous catheters: A systematic review

Purpose Air embolism is a fatal complication of central venous catheter (CVC) manipulation. Its delayed occurrence after CVC removal is poorly understood and underrecognized. We conducted a systematic review to identify all delayed air embolism following CVC removal. Material and methods We included case reports or case series that described venous or paradoxical air embolism occurring ≥10 min after CVC removal. Data extracted included patient demographics, catheter characteristics, removal technique, timing of symptoms onset, clinical presentation, diagnostic tools used, management or treatment and outcomes. Results Twenty-eight case reports were identified. Symptoms developed between ten minutes and one hour after removal of CVC in 54% of cases, between one and two hours in 14%, and after more than two hours in 32%. Neurological manifestations occurred in 92% of patients, oxygen desaturation in 90%, and cardiovascular instability in 47%; cardiac arrest was reported in only two cases. In 10 out of the 11 patients in which diagnostic tools were used to identify a cause, a transcutaneous channel was found. Ten patients were investigated for a patent foramen ovale (PFO), and six of them were negative. 18% had permanent neurological impairment and 32% died. Conclusions Delayed air embolism after CVC removal is an uncommon but potentially severe complication associated with substantial morbidity and mortality. Persistent venous-to-atmospheric communication was identified by imaging techniques in >90% of cases. Increased vigilance during and after CVC removal is necessary to improve future clinical practice.