Supportive care with 100% FIO2 only versus traditional therapies for STEMI given the underlying pathophysiology is not that of plaque or coronary thrombus.
Somewhat surprisingly, the patient did well. He was intubated electively as he was deteriorating and to put him on true 100% oxygen (non-rebreathing masks do not provide 100% oxygen in most situations). HBOT was sought, but no beds available, so he was kept on 100% oxygen despite PaO2 of > 100 mmHg for 24 hours. He was extubated in two days with no clear neurological sequelae, but a diagnosis of adenocarcinoma of the rectum with pulmonary metastases was made after reviewing the biopsy.
Presumably the air bubbles were broken up by the turbulence of the blood flow and gradual dissolution of the oxygen and CO2 into the blood. It is unlikely that a true randomized, double-blind placebo, controlled, multi-center study will be conducted and clinicians will have to rely on theory, anecdote and perhaps common sense.
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Reference
1. Malik N, Claus PL, Illman JE, et al. Air embolism: diagnosis and management. Future Cardiol. 2017 Jul;13(4):365-78. [CrossRef] [PubMed]