Acute right ventricular failure and pulseless electrical activity arrest following auto-transfusion of blood

Air embolism is a rare but potentially catastrophic complication of interventional procedures. The occurrence of acute right ventricular dysfunction during intraoperative auto-transfusion of blood, presumably related to pulmonary embolism of agitated air microbubbles and microthrombi, is less commonly recognized. We report a case of auto-transfusion complicated by acute right ventricular failure and pulseless electrical activity arrest. Auto-transfusion of recovered blood is a practical solution to reduce need for post-procedure allogenic transfusions. Although such interventions are frequently performed without complications, they do have inherent risks that should be readily acknowledged. This case clearly describes a severe complication and sequelae of auto-transfusion. <Learning objective: Auto-transfusion of recovered blood is commonly performed in surgical and interventional procedures to reduce the need for allogenic transfusion. Despite this benefit, the risks and complications of auto-transfusion can be severe and must be considered. We report a case of intraprocedural auto-transfusion resulting in introduction of air emboli and subsequent cardiac arrest. Additionally, we provide a brief review of air emboli and underlying pathophysiology that leads to cardiovascular decline.>