Air embolism is one of those complications that feels impossible right up until it happens fast, quietly, and with life-altering consequences. We walk through the FDA’s 2025 Early Alert on the Watchman access system for left atrial appendage occlusion (LAAO) procedures and connect the dots between device exchange steps, transseptal puncture, and the anesthetic choice that can put patients at risk.

We talk about why the shift toward sedation and spontaneous ventilation in structural heart procedures can increase risk when an access system is open or imperfectly sealed. Negative intrathoracic pressure may create a suction gradient that favors air entry into the left atrium, where even small volumes can lead to coronary air embolism or cerebral air embolism. We also review what the FDA reported, including known cases of serious injury and death, and why registry rates may underestimate true events.

From there, we translate guidance into practical anesthesia patient safety moves you can use in the interventional cardiology suite: when to consider controlled positive pressure ventilation and PEEP, what to watch during sheath manipulation, and how to set clear roles for sheath control, flushing, and line management. We cover prevention details like keeping components below the level of the heart, slow flushing to maintain a continuous fluid column, and performing exchanges under saline or water baths. We also outline an immediate response plan: recognize quickly, support hemodynamics, consider Trendelenburg positioning, aspirate air if indicated, and activate perfusion support early when available.

If this topic touches your practice, share this with your cardiology and anesthesia team, then subscribe, leave a review, and send the episode to a colleague who does transseptal cases. What does your team do to prevent air entrainment during exchanges?

For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/318-air-embolism-alert/

#318 Air Embolism Alert

Anesthesia Patient Safety Podcast

#318 Air Embolism Alert