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Background
Venous gas embolisms are most frequently observed at autopsy in connection with traumatic findings and lesions of larger vessels. Furthermore, it can also occur in puncture of central veins under cardiopulmonary resuscitation (CPR). Isolated arterial gas embolisms represent an unusual finding. According to literature, they occur during surgery on large arteries or in lung injuries with a shortcut between the bronchial tree and the pulmonary veins. Arterial air embolisms have been described in a few isolated cases, in particular during CPR in infants with lung tissue damage or as a consequence of direct lung trauma in combination with barotrauma due to high pressure ventilation.
Case Report
In the present case, a 25-year-old woman collapsed and eventually died after long out-of-hospital resuscitation, supported by a mechanical resuscitation device (Autopulse®). Forensic autopsy revealed a central pulmonary thrombembolism (PE) with a subacute peripheral vein thrombosis as the cause of death. Concomitantly, the postmortem computed tomography (PMCT) showed a gas accumulation with left ventricular and predominantly arterial distribution pattern, whereby the venous system and the right ventricle were not affected (no putrefaction).
The constellation of these findings raised the question of a causal connection, on the one hand with the lung pathology, on the other hand with the CPR using Autopulse® and ventilation. In the case presentation different pathophysiological considerations shall be discussed.