Gas flow during bronchoscopic ablation therapy causes gas emboli to the heart: A comparative animal study

David Feller-Kopman, Jeanne M. Lukanich, Gil Shapira, Uri Kolodny, Baruch Schori, Heather Edenfield, Burak Temelkuran, Armin Ernst, Yair Schindel, Yoel Fink, Jon Fox, Raphael Bueno

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Thermal ablation is one of the most commonly used modalities to treat central airway obstruction. Both laser and argon plasma coagulation (APC) have been reported to cause gas emboli and cardiac arrest. We sought to determine whether bronchoscopic ablation therapy can result in systemic gas emboli, correlate their presence with the rate of gas flow, and establish whether a zero-flow (ZF) modality would result in the significant reduction or elimination of emboli. Methods: CO2 laser delivered through a photonic bandgap fiber (PBF) and APC were applied in the trachea and mainstem bronchi of six anesthetized sheep at varying dosages and gas flow rates. Direct epicardial echocardiography was used to obtain a four-chamber view and detect gas emboli. Results: The presence of gas flow accompanying APC and the CO 2 laser with forward flow correlated significantly with the appearance of gas bubbles in the atria. A definite dose response was observed between the gas flow rate and the number of bubbles seen. When the CO 2 laser was delivered through a PBF with ZF to the trachea or bronchi, no bubbles were observed. Conclusion: Bronchoscopic thermal ablation therapy using gas flow is associated with gas emboli in a dose-dependent fashion. The use of the flexible PBF with ZF is not associated with the development of gas emboli. Further study is required to determine whether a clinically safe threshold of gas emboli exists, and the relationships among the pathologic depth of tissue destruction, gas flow, pulse duration, and the development of gas emboli.

Original languageEnglish (US)
Pages (from-to)892-896
Number of pages5
JournalCHEST
Volume133
Issue number4
DOIs
StatePublished - Apr 2008

Keywords

  • Bronchoscopy
  • Central airway obstruction
  • Gas emboli
  • Laser
  • Thermal ablation

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

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