title: Massive carbon dioxide gas embolism: a near catastrophic situation averted by use of cardiopulmonary bypass.
abstract: Endovascular vein harvesting is used as a less invasive method when compared to the standard open surgical method of dissecting and procurement of the greater saphenous vein. The benefits include smaller incision, decreased blood loss, less pain, decreased transfusion, decreased risk of infection and enhanced epidermal cosmetics. However, endovascular vein harvesting does have a learning curve to master the technique and although endovascular vein harvesting is the preferred standard of practice over the open surgical technique, it does have inherent potential complications. During endovascular vein harvesting, there is a potential for the patient's circulatory system to collapse which can be identified initially through hemodynamic monitoring, blood gas results, and vigilance through clinical observation. The suspected source of the crisis was confirmed when the surgeon cannulated the right atrium, where a massive gas source that (appeared pressurized) escaped upon incision of the right atrial appendage. Cardiopulmonary bypass (CPB) was utilized to support the patient and rectify the impending catastrophic event. Once full CPB was attained, we achieved hemodynamic stability and eventually all blood gases were normalized. Massive CO2 embolism is a life threatening emergency which must be identified and corrected instantaneously. CPB was the modality used to salvage this situation. Attention to the set-up of the EVH equipment, use of the transesophageal echocardiography, cerebral cximetry, vigilance and cooperation of all disciplines in the OR are definite recommendations to prevent such an occurrence. Experience gained by the perfusion team with a previous case was applied and helped to solve the immediate problems presented in this case.
authors.affiliation: Department of Cardiovascular Surgery, Frankford Hospital, Philadelphia, Pennsylvania 19114, USA. hazccp@yahoo.com
authors.forename: Hasratt
authors.initials: H
authors.lastname: Mohamed
authors.forename: Theodore
authors.initials: T
authors.lastname: Zombolas
authors.forename: John
authors.initials: J
authors.lastname: Schultz
authors.forename: Mike
authors.initials: M
authors.lastname: Krzyzewski
authors.forename: Randy
authors.initials: R
authors.lastname: Metcalf
authors.forename: Brian
authors.initials: B
authors.lastname: Yuskevich
authors.forename: Edo
authors.initials: E
authors.lastname: Ginsburg
mesh_terms: D002245:Carbon Dioxide / Q000097:blood*; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass; D004618:Embolism, Air / Q000601:surgery*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000601:surgery*; D008875:Middle Aged; D020858:Tissue and Organ Harvesting / Q000009:adverse effects
chemical_list: D002245:Carbon Dioxide
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