Purpose Venous air embolism (VAE) during pars plana vitrectomy (PPV) can occur owing to improper positioning of the infusion cannula in the suprachoroidal space and may lead to sudden compromise of cardiac circulation and death. This was an in vivo demonstration of fatal VAE during PPV to show that air can travel from the suprachoroidal space into the central circulation. Design Experimental in vivo surgical study on porcine eyes. Methods Experimental PPV under general anesthesia was performed on porcine eyes (Yorkshire species) at a University Surgical Training & Education Center. Infusion cannulas were placed into the suprachoroidal space and fluid–air exchange (FAE) was started with sequential increases in infusion air pressure. Vital signs of porcine animals were continuously monitored and recorded in real time during the PPV, including end-tidal carbon dioxide (ETCO2), oxygen saturation (SaO2), intra-arterial blood pressure, electrocardiography (EKG), and transesophageal echocardiography (TEE). Results Intracardiac air was detected on TEE less than 30 seconds after increasing air infusion pressure to 60 mm Hg. ETCO2 declined precipitously, followed by hypotension and EKG changes. Oxygen desaturation was a late phenomenon. The animal died within 7 minutes of VAE. During autopsy, the heart was open under water and air escaped from the right ventricle. Conclusion This in vivo porcine model confirms that during the FAE in PPV, pressurized air from an infusion cannula malpositioned in the suprachoroidal space can transit through the eye to the central circulation, resulting in fatal VAE.
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