Procedure-related cerebral air embolism: Systematic review and individual participant data meta-analysis

Abstract

Introduction

Cerebral air embolism (CAE) is a rare, life-threatening condition often caused by iatrogenic procedures. Despite numerous case reports, there are limited systematic reviews, with insufficient data integration for clinical application. This study aims to analyze procedure-related CAEs, focusing on clinical characteristics, diagnostic methods, and outcomes.

Methods

A systematic review and single-patient analysis were conducted using PubMed, Embase, and Cochrane (2015–2024), supplemented by one institutional case. Descriptive statistics examined demographics, presentation, diagnostics, and outcomes. Kruskal-Wallis and Fisher’s exact tests compared clinical differences across procedures, while univariable logistic regression identified mortality risk factors.

Results

The study analysed 132 patients (65.2 % male, median age 68), with minimally invasive pulmonary interventions being the most common procedure (24.2 %). Motor dysfunction (78 %) and altered consciousness (42.4 %) were the most frequent symptoms. Post-treatment, 63.1 % of motor and sensory symptoms resolved, with high recovery rates for visual (93 %) and language impairments (69 %). The mortality rate was 30.5 %. In logistic regression, cranial nerve symptoms, coma, cardiac angiography, and intervention were associated with increased mortality, while motor deficit and hyperbaric oxygen therapy were protective factors (p < 0.05).

Conclusion

Our study synthesized smaller studies to establish a clinically relevant CAE profile, emphasizing neurological patterns, diagnostic methods, and outcomes across procedures. Motor deficits and altered consciousness were the most common presentations, while cranial nerve dysfunction, coma, and cardiac angiography and interventions were significant mortality predictors. These findings offer valuable insights for early CAE identification and management, improving overall patient outcomes.