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Arterial Gas Embolism

(Air Embolism)


Richard E. Moon

, MD, Duke University Medical Center

Reviewed/Revised Apr 2023

Arterial gas embolism is blockage of blood supply to organs caused by bubbles in an artery. It is a leading cause of death among underwater divers, such as scuba divers, who breathe compressed air.

  • Within a few minutes of reaching the surface, divers can lose consciousness or develop symptoms similar to those of a stroke Stroke .

  • People are given oxygen, made to lie down, and sent as soon as possible to a recompression chamber.

Arterial gas embolism (sometimes referred to as AGE in the diving literature) is a leading cause of death among divers.

Symptoms of Arterial Gas Embolism

Symptoms of arterial gas embolism usually appear within a few minutes of reaching the surface. Arterial gas embolism to the brain often resembles a stroke, resulting in confusion and partial paralysis or loss of sensation. Some people have sudden loss of consciousness or seizures. Severe arterial gas embolism can lead to shock Shock Shock is a life-threatening condition in which blood flow to the organs is low, decreasing delivery of oxygen and thus causing organ damage and sometimes death. Blood pressure is usually low... read more and death.

Other symptoms may result from an underlying lung (pulmonary) barotrauma or decompression sickness, or from arterial gas embolism in any of the following:

  • Arteries of the heart (heart attack, abnormal heart rhythms, cardiac arrest)

  • Skin (purple-blue skin blotching, pale tongue)

  • Kidneys (blood or protein in urine, acute kidney injury)

Diagnosis of Arterial Gas Embolism

  • Based on diving history and loss of consciousness

Divers who lose consciousness during ascent or very shortly afterward are assumed to have arterial gas embolism. They must be treated promptly. Imaging tests are sometimes done but are not always reliable.

Did You Know...

  • Any diver who loses consciousness shortly after surfacing should be assumed to have arterial gas embolism and should be treated with hyperbaric oxygen as quickly as possible.

Treatment of Arterial Gas Embolism

People with arterial gas embolism are immediately made to lie down and given oxygen. They must be returned as soon as possible to a high-pressure environment, so that the air bubbles are compressed and forced to dissolve in the blood. Many medical centers have high-pressure (recompression or hyperbaric) chambers for this purpose.

Flying, even at a low altitude, reduces atmospheric pressure and allows bubbles to expand further, but it can be justified if it saves substantial time in getting people to a suitable chamber. If possible, people should fly in a plane pressurized to sea level, or the plane should fly at as low an altitude as is consistent with safety. Breathing supplemental oxygen is also recommended.

More Information

The following English-language resources may be useful. Please note that THE MANUAL is not responsible for the content of these resources.

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