Arterial gas embolism is blockage of blood supply to organs caused by bubbles in an artery. It is a leading cause of death among underwater divers, such as scuba divers, who breathe compressed air.
Within a few minutes of reaching the surface, divers can lose consciousness or develop symptoms similar to those of a stroke.
People are given oxygen, made to lie down, and sent as soon as possible to a recompression chamber.
(See also Overview of Diving Injuries.)
Air bubbles can enter arterial or venous blood (air embolism—see Unusual Types of Emboli) after pulmonary (lung) barotrauma or decompression sickness. When bubbles occur in arteries, they may travel to any organ in the body and block small blood vessels, most commonly those of the brain, but also of the heart, skin, and kidneys. A very large air embolism can block flow in the heart chambers or the large arteries. When bubbles occur in veins, they may pass into the arteries through heart defects such as a patent foramen ovale or atrial septal defect.
Arterial gas embolism (sometimes referred to as AGE in the diving literature) is a leading cause of death among divers.
Symptoms of Arterial Gas Embolism
Symptoms of arterial gas embolism usually appear within a few minutes of reaching the surface. Arterial gas embolism to the brain often resembles a stroke, resulting in confusion and partial paralysis or loss of sensation. Some people have sudden loss of consciousness or seizures. Severe arterial gas embolism can lead to shock and death.
Other symptoms may result from an underlying lung (pulmonary) barotrauma or decompression sickness, or from arterial gas embolism in any of the following:
Arteries of the heart (heart attack, abnormal heart rhythms, cardiac arrest)
Skin (purple-blue skin blotching, pale tongue)
Kidneys (blood or protein in urine, acute kidney injury)
Diagnosis of Arterial Gas Embolism
Based on diving history and loss of consciousness
Divers who lose consciousness during ascent or very shortly afterward are assumed to have arterial gas embolism. They must be treated promptly. Imaging tests are sometimes done but are not always reliable.
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Treatment of Arterial Gas Embolism
People with arterial gas embolism are immediately made to lie down and given oxygen. They must be returned as soon as possible to a high-pressure environment, so that the air bubbles are compressed and forced to dissolve in the blood. Many medical centers have high-pressure (recompression or hyperbaric) chambers for this purpose.
Flying, even at a low altitude, reduces atmospheric pressure and allows bubbles to expand further, but it can be justified if it saves substantial time in getting people to a suitable chamber. If possible, people should fly in a plane pressurized to sea level, or the plane should fly at as low an altitude as is consistent with safety. Breathing supplemental oxygen is also recommended.
More Information
The following English-language resources may be useful. Please note that THE MANUAL is not responsible for the content of these resources.
Divers Alert Network: 24-hour emergency hotline, 919-684-9111
Duke Dive Medicine: 24-hour emergency medical consultation, 919-684-8111
