• Ji-Ling Guo, Han-Bing Wang, Hong Wang, Yue Le, Jian He, Xue-Qin Zheng, Zhi-Hao Zhang, and Guang-Rong Duan.
• Guangdong Medical University. Wenming East Road No.2, Zhanjiang.
• Medicine (Baltimore). 2021 Jun 11; 100 (23): e26304e26304.

IntroductionAir embolism has the potential to be serious and fatal. In this paper, we report 3 cases of air embolism associated with endoscopic medical procedures in which the patients were treated with hyperbaric oxygen immediately after diagnosis by transesophageal echocardiography. In addition, we systematically review the risk factors for air embolism, clinical presentation, treatment, and the importance of early hyperbaric oxygen therapy efficacy after recognition of air embolism.Patient ConcernsWe present 3 patients with varying degrees of air embolism during endoscopic procedures, one of which was fatal, with large amounts of gas visible in the right and left heart chambers and pulmonary artery, 1 showing right heart enlargement with increased pulmonary artery pressure and tricuspid regurgitation, and 1 showing only a small amount of gas images in the heart chambers.DiagnosesBased on ETCO2 and transesophageal echocardiography (TEE), diagnoses of air embolism were made.InterventionsThe patients received symptomatic supportive therapy including CPR, 100% O2 ventilation, cerebral protection, hyperbaric oxygen therapy and rehabilitation.OutcomesAir embolism can causes respiratory, circulatory and neurological dysfunction. After aggressive treatment, one of the 3 patients died, 1 had permanent visual impairment, and 1 recovered completely without comorbidities.ConclusionsWhile it is common for small amounts of air/air bubbles to enter the circulatory system during endoscopic procedures, life-threatening air embolism is rare. Air embolism can lead to serious consequences, including respiratory, circulatory, and neurological impairment. Therefore, early recognition of severe air embolism and prompt hyperbaric oxygen therapy are essential to avoid its serious complications.Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

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