Robotic-Assisted Navigational Bronchoscopy Complicated by Systemic Air Embolism

BACKGROUND: Robotic-assisted bronchoscopy (RAB) is a minimally invasive modality with a highly favorable safety profile. Systemic air embolism (SAE) is an exceedingly rare and catastrophic complication that is only recently emerging in literature surrounding RAB. CASE SUMMARY: A 74-year-old woman undergoing RAB developed an immediate ST-elevation myocardial infarction, airway bleeding, and cardiac arrest. Angiography revealed nonobstructive coronary arteries but identified a massive air embolism in the left ventricular apex. Her hospital course was complicated by severe cerebral edema, seizures, and acute limb ischemia. DISCUSSION: We highlight a catastrophic instance of SAE resulting from RAB. We discuss its pathophysiology, imaging limitations, and the severe contraindications precluding hyperbaric oxygen therapy in patients with underlying structural lung disease. TAKE-HOME MESSAGES: SAE is a life-threatening RAB complication that can mimic acute coronary syndrome. Minimally invasive procedures carry fatal risks, especially in patients lacking the physiologic reserve to tolerate vital rescue treatments.