Gas flow during bronchoscopic ablation therapy causes gas emboli to the heart: a comparative animal study

Chest
David Feller-KopmanRaphael Bueno

Abstract

Thermal ablation is one of the most commonly used modalities to treat central airway obstruction. Both laser and argon plasma coagulation (APC) have been reported to cause gas emboli and cardiac arrest. We sought to determine whether bronchoscopic ablation therapy can result in systemic gas emboli, correlate their presence with the rate of gas flow, and establish whether a zero-flow (ZF) modality would result in the significant reduction or elimination of emboli. CO(2) laser delivered through a photonic bandgap fiber (PBF) and APC were applied in the trachea and mainstem bronchi of six anesthetized sheep at varying dosages and gas flow rates. Direct epicardial echocardiography was used to obtain a four-chamber view and detect gas emboli. The presence of gas flow accompanying APC and the CO(2) laser with forward flow correlated significantly with the appearance of gas bubbles in the atria. A definite dose response was observed between the gas flow rate and the number of bubbles seen. When the CO(2) laser was delivered through a PBF with ZF to the trachea or bronchi, no bubbles were observed. Bronchoscopic thermal ablation therapy using gas flow is associated with gas emboli in a dose-dependent fashion. The use of the flexible PB...Continue Reading

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Citations

Mar 20, 2009·Current Opinion in Anaesthesiology·Alan Frederick Ross, J Scott Ferguson
Apr 1, 2009·Journal of Bronchology & Interventional Pulmonology·Ai-Ping Chua, Atul C Mehta
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Oct 27, 2016·Current Opinion in Anaesthesiology·Angela Roberts SelzerEugene Shostak
Jun 19, 2009·Current Opinion in Ophthalmology

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