{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T21:05:24Z","timestamp":1792184724698,"version":"4.4.0"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2025,9,22]],"date-time":"2025-09-22T00:00:00Z","timestamp":1758499200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"Technology Research Program of Chongqing Municipal Education Commission","award":["KJQN202500133"],"award-info":[{"award-number":["KJQN202500133"]}]},{"name":"Foundation of Chongqing University Cancer Hospital","award":["2023nlts008"],"award-info":[{"award-number":["2023nlts008"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,10,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>To evaluate the incidence of air embolism and explore the underlying mechanisms and treatment strategies during intraoperative lung nodule localization under general anaesthesia in hybrid room.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>From June 2021 to October 2024, patients with suspicious lung nodule scheduled to elective surgery requiring intraoperative nodule localization in hybrid room were retrospectively studied. Lung nodule localization was performed under anaesthesia and intubation with computed tomography (CT) guidance, followed by repeat whole thorax scan to detect any complications. CT images were retrospectively evaluated by 2 radiologists and air embolism was defined as filling defect in main vessels or the heart.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of 1582 cases were reviewed, and 7 cases of air embolism (median age, 54 years; range, 36-68 years; 4 men) were detected, with an incidence of 0.44%. The median distance from the pleura to the target lesion was 25 mm (range, 10-60 mm). The median target lesion size was 8 mm (range, 6-15 mm). Identifiable vein branch adjacent to target nodule could be found in 6 (85.7%) patients. In 5 cases, air embolism was detected immediately after the procedure, while retrospectively revealed in 2 cases after surgery. Four (57.1%) patients developed related symptoms, including intraoperative cardiac arrest, blood pressure decline, postoperative hemiplegia, and visually impair. Cardiopulmonary resuscitation with chest compression was required in 2 patients. Adjustment to the Trendelenburg position was performed in 4 patients.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The increased risk of air embolism should be emphasized during intraoperative lung nodule localization in hybrid room, which might be related to the abnormal bronchial-vein fistula caused by the puncture and positive pressure ventilation. Avoiding pulmonary vein injury with careful planning of the needle pathway on CT and holding the ventilator during the puncture procedure may reduce the risk of air embolism.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ejcts\/ezaf301","type":"journal-article","created":{"date-parts":[[2025,9,22]],"date-time":"2025-09-22T13:28:25Z","timestamp":1758547705000},"source":"Crossref","is-referenced-by-count":2,"title":["Risk of Air Embolism and On-site Management during Intraoperative Lung Nodule Localization in Hybrid Room: 7 Cases from a Single Institute"],"prefix":"10.1093","volume":"67","author":[{"given":"Xianping","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Thoracic Oncology, Chongqing University Cancer Hospital , Chongqing 400030,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huajie","family":"Xing","sequence":"additional","affiliation":[{"name":"Department of Thoracic Oncology, Chongqing University Cancer Hospital , Chongqing 400030,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiqiang","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Thoracic Oncology, Chongqing University Cancer Hospital , Chongqing 400030,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,9,22]]},"reference":[{"key":"2025100619563012100_ezaf301-B1","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1016\/s1010-7940(00)00411-5","article-title":"A pilot study of the role of TC-99 radionuclide in localization of pulmonary nodular lesions for thoracoscopic resection","volume":"18","author":"Chella","year":"2000","journal-title":"Eur J Cardio-Thorac Surg."},{"key":"2025100619563012100_ezaf301-B2","doi-asserted-by":"publisher","first-page":"248","DOI":"10.1186\/s12957-015-0664-9","article-title":"Localization of nonpalpable pulmonary nodules using CT-guided needle puncture","volume":"13","author":"Hsu","year":"2015","journal-title":"World J Surg Oncol"},{"key":"2025100619563012100_ezaf301-B3","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1186\/s13019-016-0404-4","article-title":"Pre-operative localization of solitary pulmonary nodules with computed tomography-guided hook wire: report of 181 patients","volume":"11","author":"Hanauer","year":"2016","journal-title":"J Cardiothorac Surg"},{"key":"2025100619563012100_ezaf301-B4","doi-asserted-by":"publisher","first-page":"2140","DOI":"10.1016\/j.jtcvs.2018.01.007","article-title":"Needle localization of small pulmonary nodules: lessons learned","volume":"155","author":"Thistlethwaite","year":"2018","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2025100619563012100_ezaf301-B5","doi-asserted-by":"publisher","first-page":"138","DOI":"10.1007\/s00330-016-4357-8","article-title":"Complication rates of CT-guided transthoracic lung biopsy: meta-analysis","volume":"27","author":"Heerink","year":"2017","journal-title":"Eur Radiol"},{"key":"2025100619563012100_ezaf301-B6","doi-asserted-by":"publisher","first-page":"W184","DOI":"10.2214\/ajr.16.16048","article-title":"Measures to prevent air embolism in transthoracic biopsy of the lung","volume":"208","author":"Glodny","year":"2017","journal-title":"AJR Am J Roentgenol"},{"key":"2025100619563012100_ezaf301-B7","doi-asserted-by":"publisher","first-page":"1312","DOI":"10.1007\/s00270-013-0808-7","article-title":"Risk factors for systemic air embolism as a complication of percutaneous CT-guided lung biopsy: multicenter case-control study","volume":"37","author":"Ishii","year":"2014","journal-title":"Cardiovasc Intervent Radiol"},{"key":"2025100619563012100_ezaf301-B8","doi-asserted-by":"publisher","first-page":"e83-5","DOI":"10.1259\/bjr\/39096533","article-title":"Coronary artery air embolism: a potentially fatal complication of CT-guided percutaneous lung biopsy","volume":"83","author":"Cheng","year":"2010","journal-title":"Br J Radiol"},{"key":"2025100619563012100_ezaf301-B9","doi-asserted-by":"publisher","first-page":"68","DOI":"10.5334\/jbsr.2266","article-title":"Acute coronary artery air-embolism after percutaneous lung biopsy","volume":"104","author":"Grandjean","year":"2020","journal-title":"J Belg Soc Radiol"},{"key":"2025100619563012100_ezaf301-B10","doi-asserted-by":"publisher","first-page":"993","DOI":"10.1378\/chest.121.3.993","article-title":"Coronary artery air embolism complicating a CT-guided transthoracic needle biopsy of the lung","volume":"121","author":"Mokhlesi","year":"2002","journal-title":"Chest"},{"key":"2025100619563012100_ezaf301-B11","doi-asserted-by":"publisher","first-page":"6800","DOI":"10.1007\/s00330-022-09079-6","article-title":"Air embolism in CT-guided transthoracic needle biopsy: emphasis on pulmonary vein injury","volume":"32","author":"Ahn","year":"2022","journal-title":"Eur Radiol"},{"key":"2025100619563012100_ezaf301-B12","doi-asserted-by":"publisher","first-page":"684","DOI":"10.1378\/chest.06-3030","article-title":"Nonfatal systemic air embolism complicating percutaneous CT-guided transthoracic needle biopsy: four cases from a single institution","volume":"132","author":"Hiraki","year":"2007","journal-title":"Chest"},{"key":"2025100619563012100_ezaf301-B13","doi-asserted-by":"publisher","first-page":"353","DOI":"10.1007\/s10140-007-0685-y","article-title":"Systemic air embolism after percutaneous transthorasic needle biopsy of the lung","volume":"15","author":"Ghafoori","year":"2008","journal-title":"Emerg Radiol"},{"key":"2025100619563012100_ezaf301-B14","doi-asserted-by":"publisher","first-page":"S731","DOI":"10.21037\/jtd.2016.09.47","article-title":"Image-guided localization of small lung nodules in video-assisted thoracic surgery","volume":"8","author":"Zhao","year":"2016","journal-title":"J Thorac Dis"},{"key":"2025100619563012100_ezaf301-B15","doi-asserted-by":"publisher","first-page":"488","DOI":"10.1093\/ejcts\/ezz292","article-title":"Preoperative versus intraoperative image-guided localization of multiple ipsilateral lung nodules","volume":"57","author":"Chao","year":"2020","journal-title":"Eur J Cardio-Thorac Surg"},{"key":"2025100619563012100_ezaf301-B16","doi-asserted-by":"publisher","first-page":"809908","DOI":"10.3389\/fsurg.2021.809908","article-title":"Efficacy and safety of preoperative vs. intraoperative computed tomography-guided lung tumor localization: a randomized controlled trial","volume":"8","author":"Fang","year":"2021","journal-title":"Front Surg"},{"key":"2025100619563012100_ezaf301-B17","doi-asserted-by":"publisher","first-page":"950159","DOI":"10.3389\/fsurg.2022.950159","article-title":"Case report: cerebral artery air embolism during CT-guided lung nodule resection in hybrid theater","volume":"9","author":"Xing","year":"2022","journal-title":"Front Surg"},{"key":"2025100619563012100_ezaf301-B18","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1016\/j.ejrad.2006.02.001","article-title":"CT-guided needle biopsy of lung lesions: a survey of severe complication based on 9783 biopsies in Japan","volume":"59","author":"Tomiyama","year":"2006","journal-title":"Eur J Radiol"},{"key":"2025100619563012100_ezaf301-B19","doi-asserted-by":"publisher","first-page":"476","DOI":"10.1056\/nejm200002173420706","article-title":"Gas embolism","volume":"342","author":"Muth","year":"2000","journal-title":"N Engl J Med"},{"key":"2025100619563012100_ezaf301-B20","doi-asserted-by":"publisher","first-page":"713","DOI":"10.1152\/jappl.1964.19.4.713","article-title":"Distribution of blood flow in isolated lung; relation to vascular and alveolar pressures","volume":"19","author":"West","year":"1964","journal-title":"J Appl Physiol"},{"key":"2025100619563012100_ezaf301-B21","doi-asserted-by":"publisher","first-page":"365","DOI":"10.2217\/fca-2017-0015","article-title":"Air embolism: diagnosis and management","volume":"13","author":"Malik","year":"2017","journal-title":"Future Cardiol"},{"key":"2025100619563012100_ezaf301-B22","doi-asserted-by":"publisher","first-page":"e946254","DOI":"10.12659\/ajcr.946254","article-title":"Cerebral air embolism risks in TAVR procedures: insights from a 75-year-old patient case","volume":"26","author":"Surendranath","year":"2025","journal-title":"Am J Case Rep"},{"key":"2025100619563012100_ezaf301-B23","doi-asserted-by":"publisher","first-page":"20220583","DOI":"10.1259\/bjr.20220583","article-title":"Air embolism after CT-guided localization of pulmonary ground-glass nodules","volume":"96","author":"Sun","year":"2023","journal-title":"Br J Radiol"},{"key":"2025100619563012100_ezaf301-B24","doi-asserted-by":"publisher","first-page":"589","DOI":"10.1016\/j.crad.2011.03.005","article-title":"Systemic arterial air embolism after percutaneous lung biopsy","volume":"66","author":"Hare","year":"2011","journal-title":"Clin Radiol"},{"key":"2025100619563012100_ezaf301-B25","doi-asserted-by":"publisher","first-page":"20584601221096680","DOI":"10.1177\/20584601221096680","article-title":"Systemic air embolism following computed-tomography-guided transthoracic needle biopsy of lung lesion\u2014a systematic search of case reports and case series","volume":"11","author":"Pietersen","year":"2022","journal-title":"Acta Radiol Open"},{"key":"2025100619563012100_ezaf301-B26","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1186\/1471-2466-12-2","article-title":"Systemic air embolism during percutaneous core needle biopsy of the lung: frequency and risk factors","volume":"12","author":"Freund","year":"2012","journal-title":"BMC Pulm Med"},{"key":"2025100619563012100_ezaf301-B27","doi-asserted-by":"publisher","first-page":"2022","DOI":"10.1007\/s00330-020-07372-w","article-title":"Incidence, risk factors, and prognostic indicators of symptomatic air embolism after percutaneous transthoracic lung biopsy: a systematic review and pooled analysis","volume":"31","author":"Lee","year":"2021","journal-title":"Eur Radiol"},{"key":"2025100619563012100_ezaf301-B28","doi-asserted-by":"publisher","first-page":"227","DOI":"10.1111\/1759-7714.12180","article-title":"Asymptomatic air-embolism following percutaneous radiofrequency ablation of lung tumor: rare or underestimated complication?","volume":"6","author":"Rapicetta","year":"2015","journal-title":"Thorac Cancer"},{"key":"2025100619563012100_ezaf301-B29","doi-asserted-by":"publisher","first-page":"e1087","DOI":"10.7759\/cureus.1087","article-title":"Vascular air embolism during bronchoscopy procedures - incidence, pathophysiology, diagnosis, management and outcomes","volume":"9","author":"Kanchustambham","year":"2017","journal-title":"Cureus"},{"key":"2025100619563012100_ezaf301-B30","doi-asserted-by":"publisher","first-page":"e5559","DOI":"10.7759\/cureus.5559","article-title":"A high-pressure solution for a high-pressure situation: management of cerebral air embolism with hyperbaric oxygen therapy","volume":"11","author":"Murphy","year":"2019","journal-title":"Cureus"}],"container-title":["European Journal of Cardio-Thoracic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ejcts\/advance-article-pdf\/doi\/10.1093\/ejcts\/ezaf301\/64344557\/ezaf301.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ejcts\/article-pdf\/67\/10\/ezaf301\/64344557\/ezaf301.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ejcts\/article-pdf\/67\/10\/ezaf301\/64344557\/ezaf301.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,6]],"date-time":"2025-10-06T23:56:44Z","timestamp":1759795004000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ejcts\/article\/doi\/10.1093\/ejcts\/ezaf301\/8261374"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,22]]},"references-count":30,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2025,10,2]]}},"URL":"https:\/\/doi.org\/10.1093\/ejcts\/ezaf301","relation":{},"ISSN":["1873-734X"],"issn-type":[{"value":"1873-734X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,10]]},"published":{"date-parts":[[2025,9,22]]},"article-number":"ezaf301"}}