{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T13:44:37Z","timestamp":1762868677209,"version":"3.37.3"},"reference-count":33,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,10,30]],"date-time":"2021-10-30T00:00:00Z","timestamp":1635552000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,10,30]],"date-time":"2021-10-30T00:00:00Z","timestamp":1635552000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Anesthesiol"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>During orthotopic liver transplantation, venous air embolism may occur due to iatrogenic injury of the inferior vena cava. However, venous air embolism followed by coagulopathy is a rare event. In this case report, we discuss a possible connection between venous air embolism and disseminated intravascular coagulation.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Case presentation<\/jats:title>\n                <jats:p>A 37-year-old male patient with chronic hepatitis B- and C-induced liver cirrhosis was admitted for orthotopic liver transplantation. During the dissection phase of the surgery, arterial blood pressure, heart rate, saturation and end-tidal carbon dioxide levels suddenly decreased, indicating the occurrence of venous air embolism. After stabilizing the patient\u2019s condition, various coagulation issues started developing. Venous air embolism-induced coagulopathy was handled by administering transfusions of various blood products. However, the patient\u2019s condition continued to deteriorate leading to a complete asystole.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>This is a rare case of venous air embolism-induced disseminated intravascular coagulation. The real connection remains unclear as disseminated intravascular coagulation for end-stage liver disease patients can be induced by various causes during different stages of liver transplantation. Certainly, both venous air embolism and coagulopathy were significant and led to an unfavorable outcome. Further studies are needed to better understand the possible mechanisms and correlation between these two life-threatening complications.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12871-021-01476-6","type":"journal-article","created":{"date-parts":[[2021,10,30]],"date-time":"2021-10-30T11:02:43Z","timestamp":1635591763000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Disseminated intravascular coagulation following air embolism during orthotropic liver transplantation: is this just a coincidence?"],"prefix":"10.1186","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9990-8008","authenticated-orcid":false,"given":"Karolina","family":"Arstikyte","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gintare","family":"Vitkute","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vilma","family":"Traskaite-Juskeviciene","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrius","family":"Macas","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,10,30]]},"reference":[{"issue":"5","key":"1476_CR1","doi-asserted-by":"publisher","first-page":"614","DOI":"10.1002\/hep.1840020516","volume":"2","author":"TE Starzl","year":"1982","unstructured":"Starzl TE, Iwatsuki S, Van Thiel DH, et al. Evolution of liver transplantation. Hepatology. 1982;2(5):614\u201336.","journal-title":"Hepatology."},{"key":"1476_CR2","volume-title":"Surgical procedures and anesthetic implications: a handbook for nurse anesthesia practice","author":"LF Macksey","year":"2012","unstructured":"Macksey LF. Surgical procedures and anesthetic implications: a handbook for nurse anesthesia practice. Sudbury: Jones & Bartlett Learning; 2012."},{"key":"1476_CR3","doi-asserted-by":"crossref","unstructured":"Ozier Y, Steib A. Haemostatic disorders during liver transplantation. Eur J Anaesthesiol. 2001;18(4):208\u201318.","DOI":"10.1097\/00003643-200104000-00002"},{"issue":"3","key":"1476_CR4","doi-asserted-by":"publisher","first-page":"783","DOI":"10.1016\/j.transproceed.2018.12.030","volume":"51","author":"RAS Campbell","year":"2019","unstructured":"Campbell RAS, Thomson EM, Beattie C. Effect of liver disease etiology on ROTEM profiles in patients undergoing liver transplantation. Transplant Proc. 2019;51(3):783\u20139.","journal-title":"Transplant Proc"},{"issue":"20","key":"1476_CR5","doi-asserted-by":"publisher","first-page":"6146","DOI":"10.3748\/wjg.v20.i20.6146","volume":"20","author":"B Clevenger","year":"2014","unstructured":"Clevenger B. Transfusion and coagulation management in liver transplantation. WJG. 2014;20(20):6146.","journal-title":"WJG."},{"issue":"1","key":"1476_CR6","doi-asserted-by":"publisher","first-page":"11","DOI":"10.4240\/wjgs.v11.i1.11","volume":"11","author":"MA Pinto","year":"2019","unstructured":"Pinto MA, Chedid MF, Sekine L, et al. Intraoperative cell salvage with autologous transfusion in liver transplantation. World J Gastrointest Surg. 2019;11(1):11\u20138.","journal-title":"World J Gastrointest Surg"},{"issue":"05","key":"1476_CR7","doi-asserted-by":"publisher","first-page":"474","DOI":"10.1055\/s-0035-1550437","volume":"41","author":"F Leebeek","year":"2015","unstructured":"Leebeek F, Rijken D. The Fibrinolytic status in liver diseases. Semin Thromb Hemost. 2015;41(05):474\u201380.","journal-title":"Semin Thromb Hemost"},{"issue":"2","key":"1476_CR8","doi-asserted-by":"publisher","first-page":"291","DOI":"10.5500\/wjt.v6.i2.291","volume":"6","author":"S Cleland","year":"2016","unstructured":"Cleland S, Corredor C, Ye JJ, Srinivas C, McCluskey SA. Massive haemorrhage in liver transplantation: consequences, prediction and management. WJT. 2016;6(2):291.","journal-title":"WJT."},{"issue":"5","key":"1476_CR9","doi-asserted-by":"publisher","first-page":"543","DOI":"10.4103\/0019-5049.144650","volume":"58","author":"S Sahu","year":"2014","unstructured":"Sahu S. Hemlata null, Verma a. adverse events related to blood transfusion. Indian J Anaesth. 2014;58(5):543\u201351.","journal-title":"Indian J Anaesth"},{"issue":"2","key":"1476_CR10","doi-asserted-by":"publisher","first-page":"164","DOI":"10.1177\/1089253217739689","volume":"22","author":"JH Chow","year":"2018","unstructured":"Chow JH, Lee K, Abuelkasem E, Udekwu OR, Tanaka KA. Coagulation management during liver transplantation: use of fibrinogen concentrate, recombinant activated factor VII, Prothrombin complex concentrate, and antifibrinolytics. Semin Cardiothorac Vasc Anesth. 2018;22(2):164\u201373.","journal-title":"Semin Cardiothorac Vasc Anesth"},{"issue":"2","key":"1476_CR11","doi-asserted-by":"publisher","first-page":"609","DOI":"10.1213\/ANE.0000000000002106","volume":"125","author":"E Abuelkasem","year":"2017","unstructured":"Abuelkasem E, Hasan S, Mazzeffi MA, Planinsic RM, Sakai T, Tanaka KA. Reduced requirement for Prothrombin complex concentrate for the restoration of thrombin generation in plasma from liver transplant recipients. Anesth Analg. 2017;125(2):609\u201315.","journal-title":"Anesth Analg"},{"issue":"4","key":"1476_CR12","doi-asserted-by":"publisher","first-page":"1541","DOI":"10.3748\/wjg.v22.i4.1541","volume":"22","author":"M Hartmann","year":"2016","unstructured":"Hartmann M, Szalai C, Saner FH. Hemostasis in liver transplantation: pathophysiology, monitoring, and treatment. World J Gastroenterol. 2016;22(4):1541\u201350.","journal-title":"World J Gastroenterol"},{"issue":"8","key":"1476_CR13","doi-asserted-by":"publisher","first-page":"788","DOI":"10.1111\/vox.12598","volume":"112","author":"A Blasi","year":"2017","unstructured":"Blasi A, Sabate A, Beltran J, Costa M, Reyes R, Torres F. Correlation between plasma fibrinogen and FIBTEM thromboelastometry during liver transplantation: a comprehensive assessment. Vox Sang. 2017;112(8):788\u201395.","journal-title":"Vox Sang"},{"issue":"1","key":"1476_CR14","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1016\/j.resuscitation.2012.10.025","volume":"84","author":"M Skrifvars","year":"2013","unstructured":"Skrifvars M, Pettil\u00e4 V. Disseminated intravascular coagulation is bad news for patients following cardiac arrest. Resuscitation. 2013;84(1):9\u201310.","journal-title":"Resuscitation."},{"key":"1476_CR15","doi-asserted-by":"publisher","first-page":"156","DOI":"10.3389\/fmed.2017.00156","volume":"4","author":"T Wada","year":"2017","unstructured":"Wada T. Coagulofibrinolytic changes in patients with post-cardiac arrest syndrome. Front Med. 2017;4:156.","journal-title":"Front Med"},{"issue":"5","key":"1476_CR16","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1093\/bjaceaccp\/mkl040","volume":"6","author":"D Fabbroni","year":"2006","unstructured":"Fabbroni D, Bellamy M. Anaesthesia for hepatic transplantation. Continuing Educ Anaesthesia Crit Care Pain. 2006;6(5):171\u20135.","journal-title":"Continuing Educ Anaesthesia Crit Care Pain"},{"issue":"6","key":"1476_CR17","doi-asserted-by":"publisher","first-page":"2105","DOI":"10.1053\/j.gastro.2009.08.045","volume":"137","author":"A Tripodi","year":"2009","unstructured":"Tripodi A, Primignani M, Chantarangkul V, et al. An imbalance of pro- vs anti-coagulation factors in plasma from patients with cirrhosis. Gastroenterology. 2009;137(6):2105\u201311.","journal-title":"Gastroenterology."},{"issue":"35","key":"1476_CR18","doi-asserted-by":"publisher","first-page":"10062","DOI":"10.3748\/wjg.v21.i35.10062","volume":"21","author":"A Blasi","year":"2015","unstructured":"Blasi A. Coagulopathy in liver disease: lack of an assessment tool. World J Gastroenterol. 2015;21(35):10062\u201371.","journal-title":"World J Gastroenterol"},{"issue":"8","key":"1476_CR19","doi-asserted-by":"publisher","first-page":"1491","DOI":"10.1055\/s-0038-1666861","volume":"118","author":"NM Intagliata","year":"2018","unstructured":"Intagliata NM, Argo CK, Stine JG, et al. Concepts and controversies in Haemostasis and thrombosis associated with liver disease: proceedings of the 7th international coagulation in liver disease conference. Thromb Haemost. 2018;118(8):1491\u2013506.","journal-title":"Thromb Haemost"},{"key":"1476_CR20","volume-title":"Embolic diseases - unusual therapies and challenges [internet]","author":"B Biocina","year":"2017","unstructured":"Biocina B, Petricevic M, Safradin I. Air embolism. In: Firstenberg MS, editor. Embolic diseases - unusual therapies and challenges [internet]: InTech; 2017. [cited 2020 Jan 6]. Available from: http:\/\/www.intechopen.com\/books\/embolic-diseases-unusual-therapies-and-challenges\/air-embolism."},{"key":"1476_CR21","unstructured":"Krovvidi DH, Adam Low, Dr. Naginder Singh. Air Embolism and Anaesthesia. 2016.https:\/\/resources.wfsahq.org\/atotw\/air-embolism-and-anaesthesia. Accessed 25 Oct 2016."},{"issue":"1","key":"1476_CR22","first-page":"14","volume":"106","author":"MA Mirski","year":"2007","unstructured":"Mirski MA. Diagnosis and treatment of vascular air embolism. Spinal Fusion. 2007;106(1):14.","journal-title":"Spinal Fusion"},{"issue":"1","key":"1476_CR23","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1053\/j.jvca.2012.11.016","volume":"28","author":"AC Robertson","year":"2014","unstructured":"Robertson AC, Eagle SS. Transesophageal echocardiography during Orthotopic liver transplantation: maximizing information without the distraction. J Cardiothorac Vasc Anesth. 2014;28(1):141\u201354.","journal-title":"J Cardiothorac Vasc Anesth"},{"issue":"4","key":"1476_CR24","doi-asserted-by":"publisher","first-page":"1815","DOI":"10.1053\/j.jvca.2018.02.033","volume":"32","author":"AA Dalia","year":"2018","unstructured":"Dalia AA, Flores A, Chitilian H, Fitzsimons MG. A comprehensive review of transesophageal echocardiography during Orthotopic liver transplantation. J Cardiothorac Vasc Anesth. 2018;32(4):1815\u201324.","journal-title":"J Cardiothorac Vasc Anesth"},{"issue":"1","key":"1476_CR25","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1053\/j.jvca.2014.07.017","volume":"29","author":"Y Chiang","year":"2015","unstructured":"Chiang Y, Hosseinian L, Rhee A, Itagaki S, Cavallaro P, Chikwe J. Questionable benefit of the pulmonary artery catheter after cardiac surgery in high-risk patients. J Cardiothorac Vasc Anesth. 2015;29(1):76\u201381.","journal-title":"J Cardiothorac Vasc Anesth"},{"issue":"22","key":"1476_CR26","doi-asserted-by":"publisher","first-page":"e77","DOI":"10.1016\/j.jacc.2014.07.944","volume":"64","author":"LA Fleisher","year":"2014","unstructured":"Fleisher LA, Fleischmann KE, Auerbach AD, et al. 2014 ACC\/AHA guideline on perioperative cardiovascular evaluation and Management of Patients Undergoing Noncardiac Surgery. J Am Coll Cardiol. 2014;64(22):e77\u2013137.","journal-title":"J Am Coll Cardiol"},{"issue":"6","key":"1476_CR27","doi-asserted-by":"publisher","first-page":"957","DOI":"10.1007\/s00134-018-5110-3","volume":"44","author":"J-L Teboul","year":"2018","unstructured":"Teboul J-L, Cecconi M, Scheeren TWL. Is there still a place for the swan\u2013Ganz catheter? No Intensive Care Med. 2018;44(6):957\u20139.","journal-title":"No Intensive Care Med"},{"issue":"1","key":"1476_CR28","doi-asserted-by":"publisher","DOI":"10.1590\/0100-6991e-20192039","volume":"46","author":"MEM Salviano","year":"2019","unstructured":"Salviano MEM, Lima AS, Tonelli IS, Correa HP, Chianca TCM. Primary liver graft dysfunction and non-function: integrative literature review. Rev Col Bras Cir. 2019;46(1):e2039.","journal-title":"Rev Col Bras Cir"},{"issue":"6","key":"1476_CR29","doi-asserted-by":"publisher","first-page":"736","DOI":"10.1111\/j.1399-6576.2009.01947.x","volume":"53","author":"ST Sch\u00e4fer","year":"2009","unstructured":"Sch\u00e4fer ST, Neumann A, Lindemann J, G\u00f6rlinger K, Peters J. Venous air embolism induces both platelet dysfunction and thrombocytopenia. Acta Anaesthesiol Scand. 2009;53(6):736\u201341.","journal-title":"Acta Anaesthesiol Scand"},{"issue":"5","key":"1476_CR30","doi-asserted-by":"publisher","first-page":"R98","DOI":"10.1186\/cc2362","volume":"7","author":"T Kapoor","year":"2003","unstructured":"Kapoor T, Gutierrez G. Air embolism as a cause of the systemic inflammatory response syndrome: a case report. Crit Care. 2003;7(5):R98\u2013100.","journal-title":"Crit Care"},{"issue":"4","key":"1476_CR31","doi-asserted-by":"publisher","first-page":"349","DOI":"10.4097\/kjae.2013.65.4.349","volume":"65","author":"S Moningi","year":"2013","unstructured":"Moningi S, Kulkarni D, Bhattacharjee S. Coagulopathy following venous air embolism: a disastrous consequence -a case report. Kor J Anesthesiol. 2013;65(4):349.","journal-title":"Kor J Anesthesiol"},{"issue":"3","key":"1476_CR32","doi-asserted-by":"publisher","first-page":"372","DOI":"10.4103\/0970-9185.117116","volume":"29","author":"M Kumar","year":"2013","unstructured":"Kumar M, Dash HH, Chawla R. Communication skills of anesthesiologists: an Indian perspective. J Anaesthesiol Clin Pharmacol. 2013;29(3):372\u20136.","journal-title":"J Anaesthesiol Clin Pharmacol"},{"issue":"3","key":"1476_CR33","doi-asserted-by":"publisher","first-page":"402","DOI":"10.1097\/ALN.0000000000002324","volume":"129","author":"JB Cooper","year":"2018","unstructured":"Cooper JB. Critical role of the surgeon-anesthesiologist relationship for patient safety. Anesthesiology. 2018;129(3):402\u20135.","journal-title":"Anesthesiology."}],"container-title":["BMC Anesthesiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12871-021-01476-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12871-021-01476-6\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12871-021-01476-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,10,30]],"date-time":"2021-10-30T11:03:00Z","timestamp":1635591780000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcanesthesiol.biomedcentral.com\/articles\/10.1186\/s12871-021-01476-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,10,30]]},"references-count":33,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["1476"],"URL":"https:\/\/doi.org\/10.1186\/s12871-021-01476-6","relation":{},"ISSN":["1471-2253"],"issn-type":[{"type":"electronic","value":"1471-2253"}],"subject":[],"published":{"date-parts":[[2021,10,30]]},"assertion":[{"value":"5 May 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 October 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 October 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"According to the Lithuanian Bioethics Committee, if the person\u2019s illness case will be presented in a journal in a way in which the patient\u2019s identity is not directly or indirectly revealed, the Legal Acts do not require consent from the patient. Committee reference number: 6B-19-176.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written informed consent was obtained from the patient\u2019s relative for publication of this case report and any accompanying images as the patient is deceased. A copy of written consent is available for review by the Editor of this journal.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"264"}}