Jong Hyuk Lee1, Soon Ho Yoon2, Hyunsook Hong3, Ji Young Rho4, Jin Mo Goo1. 1. Department of Radiology, Seoul National University Hospital, Seoul National College of Medicine, Seoul, South Korea. 2. Department of Radiology, Seoul National University Hospital, Seoul National College of Medicine, Seoul, South Korea. yshoka@gmail.com. 3. Medical Research Collaborating Center, Seoul National University Hospital, Seoul, South Korea. 4. Wonkwang University Hospital, Wonkwang University College of Medicine, Iksan, South Korea.
Abstract
OBJECTIVES: To determine the incidence, risk factors, and prognostic indicators of symptomatic air embolism after percutaneous transthoracic lung biopsy (PTLB) by conducting a systematic review and pooled analysis. METHODS: We searched the EMBASE and OVID-MEDLINE databases to identify studies that dealt with air embolism after PTLB and had extractable outcomes. The incidence of air embolism was pooled using a random effects model, and the causes of heterogeneity were investigated. To analyze risk factors for symptomatic embolism and unfavorable outcomes, multivariate logistic regression analysis was performed. RESULTS: The pooled incidence of symptomatic air embolism after PTLB was 0.08% (95% confidence interval [CI], 0.048-0.128%; I2 = 45%). In the subgroup analysis and meta-regression, guidance modality and study size were found to explain the heterogeneity. Of the patients with symptomatic air embolism, 32.7% had unfavorable outcomes. The presence of an underlying disease (odds ratio [OR], 5.939; 95% CI, 1.029-34.279; p = 0.046), the use of a ≥ 19-gauge needle (OR, 10.046; 95% CI, 1.103-91.469; p = 0.041), and coronary or intracranial air embolism (OR, 19.871; 95% CI, 2.725-14.925; p = 0.003) were independent risk factors for symptomatic embolism. Unfavorable outcomes were independently associated with the use of aspiration biopsy rather than core biopsy (OR, 3.302; 95% CI, 1.149-9.492; p = 0.027) and location of the air embolism in the coronary arteries or intracranial spaces (OR = 5.173; 95% CI = 1.309-20.447; p = 0.019). CONCLUSION: The pooled incidence of symptomatic air embolism after PTLB was 0.08%, and one-third of cases had sequelae or died. Identifying whether coronary or intracranial emboli exist is crucial in suspected cases of air embolism after PTLB. KEY POINTS: • The pooled incidence of symptomatic air embolism after percutaneous transthoracic lung biopsy was 0.08%, and one-third of patients with symptomatic air embolism had sequelae or died. • The risk factors for symptomatic air embolism were the presence of an underlying disease, the use of a ≥ 19-gauge needle, and coronary or intracranial air embolism. • Sequelae and death in patients with symptomatic air embolism were associated with the use of aspiration biopsy and coronary or intracranial locations of the air embolism.
OBJECTIVES: To determine the incidence, risk factors, and prognostic indicators of symptomatic air embolism after percutaneous transthoracic lung biopsy (PTLB) by conducting a systematic review and pooled analysis. METHODS: We searched the EMBASE and OVID-MEDLINE databases to identify studies that dealt with air embolism after PTLB and had extractable outcomes. The incidence of air embolism was pooled using a random effects model, and the causes of heterogeneity were investigated. To analyze risk factors for symptomatic embolism and unfavorable outcomes, multivariate logistic regression analysis was performed. RESULTS: The pooled incidence of symptomatic air embolism after PTLB was 0.08% (95% confidence interval [CI], 0.048-0.128%; I2 = 45%). In the subgroup analysis and meta-regression, guidance modality and study size were found to explain the heterogeneity. Of the patients with symptomatic air embolism, 32.7% had unfavorable outcomes. The presence of an underlying disease (odds ratio [OR], 5.939; 95% CI, 1.029-34.279; p = 0.046), the use of a ≥ 19-gauge needle (OR, 10.046; 95% CI, 1.103-91.469; p = 0.041), and coronary or intracranial air embolism (OR, 19.871; 95% CI, 2.725-14.925; p = 0.003) were independent risk factors for symptomatic embolism. Unfavorable outcomes were independently associated with the use of aspiration biopsy rather than core biopsy (OR, 3.302; 95% CI, 1.149-9.492; p = 0.027) and location of the air embolism in the coronary arteries or intracranial spaces (OR = 5.173; 95% CI = 1.309-20.447; p = 0.019). CONCLUSION: The pooled incidence of symptomatic air embolism after PTLB was 0.08%, and one-third of cases had sequelae or died. Identifying whether coronary or intracranial emboli exist is crucial in suspected cases of air embolism after PTLB. KEY POINTS: • The pooled incidence of symptomatic air embolism after percutaneous transthoracic lung biopsy was 0.08%, and one-third of patients with symptomatic air embolism had sequelae or died. • The risk factors for symptomatic air embolism were the presence of an underlying disease, the use of a ≥ 19-gauge needle, and coronary or intracranial air embolism. • Sequelae and death in patients with symptomatic air embolism were associated with the use of aspiration biopsy and coronary or intracranial locations of the air embolism.
Authors: A Manhire; M Charig; C Clelland; F Gleeson; R Miller; H Moss; K Pointon; C Richardson; E Sawicka Journal: Thorax Date: 2003-11 Impact factor: 9.139
Authors: Bernhard Glodny; Elisabeth Schönherr; Martin C Freund; Melanie Haslauer; Johannes Petersen; Alexander Loizides; Astrid E Grams; Florian Augustin; Franz J Wiedermann; Rafael Rehwald Journal: AJR Am J Roentgenol Date: 2017-03-16 Impact factor: 3.959
Authors: Sang Min Lee; Chang Min Park; Kyung Hee Lee; Young Eun Bahn; Jung Im Kim; Jin Mo Goo Journal: Radiology Date: 2013-11-27 Impact factor: 11.105
Authors: Soon Ho Yoon; Chang Min Park; Kyung Hee Lee; Kun Young Lim; Young Joo Suh; Dong Jin Im; Jin Hur; Dae Hee Han; Mi Jin Kang; Ji Yung Choo; Cherry Kim; Jung Im Kim; Hyunsook Hong Journal: Korean J Radiol Date: 2019-02 Impact factor: 3.500