Massive Arterial zyxw Air Embolism Due to Rupture of Pulsatile Assist Device: Successful Treatment zyx in the Hyperbaric Chamber zy L. Tomatis, M.D., M. Nemiroff, M.D., M. Riahi, M.D., J. Visser, M.D., E. Visser, M.D., A. Davies, D.O., D. Helentjaris, M.D., F. Stockinger, M.D., D. Kanten, R.N., M. Oosterheert, R.N., A. Valk, R.N., and D. Blietz, S.A. ABSTRACT We present the case of a patient who had rupture of a pulsatile assist device (PAD) accom- panied by massive air embolism, and the treatment that brought it to a successfuloutcome. After rupture of the skin of the PAD balloon, a massive amount of air was injected into the ascending aorta. The patient was placed in Trendelenburgposition and cooled in deep hypothermia with cardiopulmonarybypass. He was given 1 zyxwvuts gm of methylprednisolone intrave- nously, and the aortic valve replacement and double vein bypass graft were performed. After completion of the operation, the patient was partially rewarmed to 30°C central temperature and transported by ambulance to a hyperbaric chamber where he was compressed to 6 atmospheres absolute zyxwv 9 hours after the accident with clinical signs of se- vere brain dysfunction. The patient recovered com- pletely and was discharged from the hospital on the tenth postoperative day. The pulsatile assist device (PAD) is a relatively new modality introduced by Dr. David Breg- man at Columbia-Presbyterian Hospital to as- sist the poorly contractile ventricle before, during, and after heart-lung bypass. The dis- posable system consists of a thin polyurethane balloon, or "skin," inside a rigid chamber con- nected by a hose to the Datascope 80 or Data- scope System zyxwvuts 42 operated with compressed air at 9 pounds per square inch of pressure. This device is placed in the arterial line about 30 cm from the entrance of the arterial cannula into the ascending aorta. The chamber rapidly col- lapses in diastole and expands in systole, effec- tively augmenting diastolic flow to the coronary From the Butterworth Hospital, Grand Rapids, MI. Accepted for publication Aug 27, 1981. Address reprint requests to Dr. Tomatis, 21 Michigan St, NE, Grand Rapids, MI 49503. arteries, unloading the systolic ejection of 35 ml per beat. During the course of an aortic valve replace- ment with double aortocoronary vein bypass grafting, the PAD ruptured and a massive amount of air was introduced into the ascend- ing aorta. Several standard maneuvers were immediately instituted, the operation was completed, and the patient was treated in the hyperbaric chamber 9 hours after the initial episode. The patient was discharged on the tenth postoperative day completely recovered. Two years six months later he is asymptomatic, working full-time as an accountant, and ac- tively participating in sports such as golf, bicycling, and water skiing. Although three cases of PAD rupture are mentioned by Stoney and his colleagues [l] in a survey of accidents using pump oxygenators, a review of the literature failed to produce any reported cases of this nature. A 60-year-old man was admitted to Butter- worth Hospital on March 3, 1978, with a nine- month history of progressive shortness of breath. One month previously he had suffered an acute, severe episode of shortness of breath while shoveling snow. He was started on digitalis and diuretics. Cardiac catheterization revealed severe aortic stenosis with mild pul- monary hypertension plus 80% stenosis of a large, dominant right coronary artery and 60% stenosis of the left anterior descending coronary artery. In addition, ventricular contractions were poor with an ejection fraction of 0.24. Aortic valve replacement with double vein bypass grafting with the help of the PAD was scheduled on June 30, 1978. Through a median sternotomy, an 8 mm Sarns disposable cannula was placed through two pursestring sutures 604 0003-4975/81/120604-05$01.25 @ 1981 by The Society of Thoracic Surgeons