2024 FSA Podium and Poster Abstracts

P014: FAT EMBOLISM SYNDROME PRESENTING DURING TOTAL HIP HEMIARTHROPLASTY
Bradley W Gang, DO; Michael Ibrahim, MD; Adrienne Warrick, MD; University of Florida College of Medicine - Jacksonville

Introduction/Background: Fat embolism syndrome (FES) presents when there is a release of fat globules into the systemic circulation secondary to disruption of fat and marrow contents typically from trauma, surgery or other causes.This leads to microvascular occlusion and inflammatory reactions. Pulmonary involvement is a hallmark of FES, with fat emboli lodging in the pulmonary vasculature, causing respiratory distress and hypoxemia. The emboli can also travel to other organs contributing to multiorgan dysfunction. FES typically presents within 72 hours of a long bone fracture, however presentation can be delayed to as late as 10 days following the injury. 1 Fat embolism syndrome is also rarely associated with orthopedic surgical repair. The embolization of fat and marrow contents results from increased intramedullary pressure during insertion of an intramedullary implant such as a total hip prosthesis or an intramedullary nail.2 These embolic events can be observed by TEE, correlate with hemodynamic changes correlation with pulmonary embolism. Patients with good pulmonary function can tolerate the embolic load and demonstrate little cardiopulmonary compromise. Patients with poor pulmonary reserve are at risk of hypoxia, cardiopulmonary dysfunction, and possibly death.

We present a case of a 63 year old female undergoing total hip hemiarthroplasty who developed clinical signs of fat embolism while under general anesthesia with an interesting TEE finding in the patient's aorta that could be as a result of thromboembolism.

Methods: A literature review was performed using the Pubmed database, utilizing keywords such as “fat embolism syndrome” and “fat embolism during orthopedic surgery”, a review of the results was conducted.

Discussion/Conclusion: Fat embolism syndrome can lead to catastrophic cardiopulmonary collapse. Early recognition, supportive care, and aggressive management are essential for improving patient outcomes. The pathophysiology of FES involves the release of fat globules into the systemic circulation, leading to microvascular occlusion and inflammatory reactions. Pulmonary involvement is a hallmark of FES, with fat emboli lodging in the pulmonary vasculature, causing respiratory distress and hypoxemia. The emboli can also travel to other organs contributing to multiorgan dysfunction.

Although FES may be more difficult to detect while under general anesthesia, it is important to consider FES as a differential diagnosis in patients undergoing orthopedic surgery that develop sudden onset hypotension, hypoxemia, decrease in end tidal carbon dioxide, and tachycardia as missing these clinical signs could be detrimental for patient recovery.

Management for FES should be supportive care emphasizing oxygenation along with resuscitation to attenuate the stress response to hypoxemia, hypotension, and end-organ damage.3 Early recognition and supportive treatment decreases mortality and improve outcomes. 3