Air Embolism Following Lung Biopsy/Ablation and Port Placement: How I Manage It

Oleksandra Kutsenko, MD of Red Rock Radiology, delivered a presentation at the 2023 Symposium on Clinical Interventional Oncology (CIO) focusing on the significant but rare complication of air embolism associated with lung biopsies and ablations.

Oleksandra Kutsenko, MD of Red Rock Radiology, delivered a presentation at the 2023 Symposium on Clinical Interventional Oncology (CIO) focusing on the significant but rare complication of air embolism associated with lung biopsies and ablations. The session began with an emphasis on the importance of lung biopsies and ablations in obtaining crucial histologic, cell, genetic, and molecular information, particularly in the context of the evolving field of precision medicine. Dr. Kutsenko highlighted the Biomarker-Integrated Approaches of Targeted Therapy for Lung Cancer Elimination (BATTLE) trial, a groundbreaking study focusing on molecular abnormalities rather than organ systems, emphasizing the necessity of high-quality biopsy samples for molecular and genetic analysis. 

The presentation underscored the role of lung ablation as a viable alternative therapy for patients with stage one non-small-cell lung cancer who are not suitable candidates for surgical resection. Dr. Kutsenko refered to studies demonstrating the safety and efficacy of percutaneous cryoablation in treating pulmonary metastasis, emphasizing its equivalence in survival rates compared to standard treatments. 

Despite the benefits, the potential complications associated with lung biopsies and ablations, with pneumothorax being the most common and air embolism being an exceedingly rare but life-threatening occurrence, were acknowledged. The presentation included two case studies illustrating the severity of air embolism—one involving a patient treated successfully, highlighting the importance of prompt intervention, and the other resulting in death, underlining the gravity of this complication. 

Management recommendations for air embolism involve placing the patient in dependent positions, administering 100% oxygen, initiating CPR, introducing intravascular volume expansion, and considering hyperbaric oxygen therapy. Dr. Kutsenko emphasized that despite its rarity, air embolism carries a significant fatality rate of over 25%, necessitating a thorough understanding of its management. 

In summary, Dr. Kutsenko's presentation shed light on the critical role of lung biopsies and ablations in cancer patient management, emphasizing the importance of obtaining high-quality biopsy samples. The inclusion of real-case scenarios provides a practical perspective on the potentially fatal complication of air embolism, stressing the need for preparedness and timely intervention in clinical practice.