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AABIP Advocacy Committee Survey on Air Embolism during Bronchoscopic Biopsy of Lung lesions

1.Approximately how long have you been in practice?
2.Approximately how many bronchoscopic biopsies for peripheral lung lesions via any bronchoscopic technology do you perform on an annual basis?
3.Approximately how many linear EBUS-TBNA bronchoscopies for intrathoracic adenopathy do you perform on an annual basis?
4.How many cases of idiopathic cardiovascular or neurologic complications after bronchoscopic biopsy do you estimate you have had in your practice EVER?
5.Have you yourself had a case of suspected or confirmed air embolism occurring during or within 24 hours after bronchoscopy? Confirmed air embolism cases involve those with radiographic evidence of intravascular air on any imaging modality.
6.How many cases of suspected or confirmed air embolism resulting from bronchoscopic biopsy have you EVER had?
7.Are you aware of any other case of suspected or confirmed air embolism related to bronchoscopy that occurred at your institution since you have been employed there, that was not your case?
The remainder of the survey questions only apply if you yourself have EVER had a case of suspected or confirmed air embolism during bronchoscopy. If you have had multiple cases, please answer based on the most recent case you have had. If you have never had a case of confirmed or suspected air embolism from bronchoscopy, please scroll down to the END of survey and click DONE. Otherwise, please proceed to the next questions. Thank you.
8.Approximately how long ago did this event occur?
9.Approximately how old was the patient?
10.What was the gender of the patient?
11.Did the patient have any underlying pulmonary or cardiovascular disease? Please select all that apply.
12.What type of bronchoscopy was employed?
Questions 13-28 apply only to cases of air embolism which occurred during/following bronchoscopic biopsy of a parenchymal lung lesion. If the air embolism did not occur during or immediately following a lung nodule/mass biopsy, please skip to Question 27.
13.What bronchoscopy platform was used during the case?
14.What were the specifics of the lesion biopsied? Please select all that apply.
15.What type and size of lung lesion was sampled? Please select all that apply.
16.What was the highest positive end expiratory pressure (PEEP) used during the procedure? If you do not recall the specific PEEP, please select the standard used during such cases in your practice.
17.What tidal volume (TV) was used? If you do not recall the specific TV, please select the standard used during such cases in your practice.
18.Were recruitment breaths or breath-holds performed during bronchoscopy? Please select all that apply. If you do not recall specifics, please select the standards used in your practice during such cases.
19.If breath holds were performed during biopsies, please specify duration
20.If you perform recruitment breaths or breath holds, what is the max airway pressure used?
21.Which of the following adjunctive techniques were utilized, if any? Please select all that apply.
22.In what position was the patient during the lesion sampling?
23.What types of sampling techniques were performed for the lung lesion? Select all that apply.
24.If cryobiopsy was used, please specify average freeze time for biopsy
25.In your opinion, were there any additional factors regarding biopsy tools used to sample the lung lesion (sequence of tools used, number of needle aspirations, number of biopsies) which could have contributed to air embolism?
26.Did the patient cough during or immediately after biopsy?
27.Was there evidence of bleeding after the biopsy? Please select all that apply.
28.What was the position of the bronchoscope in relation to the distal airways at the time of lung biopsy?
Questions 29-32 apply only to cases of Air Embolism which occurred during linear EBUS-TBNA. If the Air Embolism did not occur during linear EBUS-TBNA, please skip to Question 33.
29.If air embolism was suspected or confirmed after linear EBUS-TBNA, which of the following instruments were used to sample the lymph node. Please click all that apply.
30.If needle aspiration was used, please specify needle gauge:
31.If air embolism was suspected or confirmed after linear EBUS-TBNA, please specify the lymph node station and estimated size of the lymph node.
32.What type of sedation/anesthesia was used for the procedure?
The last series of questions 33-45 apply to detection and management of Air Embolism.
33.When were signs/symptoms suggestive of possible air embolism first detected?
34.What were the signs/symptoms of possible air embolism? Please select all that apply.
35.Was there any other associated baro- or volutrauma complication?
36.Which is the most accurate statement regarding the diagnosis of air embolism in this case?
37.What type of brain imaging did your patient undergo to investigate the signs and symptoms of suspected air embolism? Select all that apply.
38.In addition to the imaging described above, what other imaging/testing did your patient undergo to investigate the signs and symptoms of suspected air embolism? Select all that apply.
39.For the tests selected above, when was the first test to evaluate for air embolism completed?
40.If the work up was diagnostic of air embolism, what was the confirmed diagnosis?
41.What treatments did the patient receive? Please select all that apply.
42.If the patient underwent hyperbaric oxygen therapy, when was it initiated?
43.Does your institution offer hyperbaric oxygen therapy?
44.What were the initial and ultimate outcomes for the patient? Please select all that apply.
45.Any other comments related to the specific case you described would be greatly appreciated. Please include whatever you think was relevant to the patient or procedure, especially if it was not addressed in the questions above. Please do not include any identifiable information about the patient, yourself or your institution!
Thank you for completing this survey!