Iatrogenic air embolism

In a recent letter to the editors of Anesthesiology, John Benumof pleads for recognition that externally pressurized blood reinfusion bags are a predicable and preventable cause of fatal air embolism (Anesthesiology 2007;207:851).  He notes that many brands of blood salvage bags require the entry of 80 plus ml of air and that the final amount of air in the bag can be much higher.  He personally has reviewed 8 fatalities in the past 10 – 12 years related to pressurizing recovered blood.  He relates the basic scenario as follows: “multiple bowls of salvaged blood were processed without purging air from the reinfusion bag, the reinfusion bag was externally pressurized {to increase flow}, there was a sudden cardiac arrest within 1 minute of the reinfusion bag being emptied of blood, there was a failed resuscitation attempt (including aspiration of air from central veins), and the autopsy showed a heart filled with air.”  He opines that reinfusion blood bags that have been filled with salvaged blood should never be externally pressurized.

David S. Smith, M.D., Ph.D.