title: Successful resuscitation of cardiac arrest caused by CO2 embolism with intra-aortic injection of epinephrine during off-pump coronary bypass surgery -a case report-.
abstract: Although compressed gas (CO2) blowers have been used safely to aid accurate grafting during off-pump coronary bypass surgery, hemodynamic collapse due to gas embolism into the right coronary artery may occur. Supportive measures to facilitate gas clearance by increasing the coronary perfusion pressure have been reported to be successful in restoring hemodynamic stability. However, right ventricular dysfunction and atrioventricular nodal ischemia may hinder effective systemic delivery of the vasoactive medications, even when performing resuscitative measures such as direct cardiac massage. We herein report a case of cardiac arrest that was caused by a right coronary gas embolism and that could not be restored by cardiac resuscitation. When supportive measures fail, direct aortic injection of epinephrine to increase the coronary perfusion pressure can be attempted before initiating cardiopulmonary bypass, and this approach may be life-saving in situations that limit systemic drug delivery from the venous side despite the performance of direct cardiac massage.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Inha University College of Medicine, Incheon, Korea.
authors.forename: Choon Soo
authors.initials: CS
authors.lastname: Lee
authors.affiliation: Department of Anesthesiology and Pain Medicine, Inha University College of Medicine, Incheon, Korea.
authors.forename: Yeo Sam
authors.initials: YS
authors.lastname: Yoon
authors.affiliation: Department of Anesthesiology and Pain Medicine, and Anesthesia and Pain Research institute, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jae-Kwang
authors.initials: JK
authors.lastname: Shim
authors.affiliation: Department of Anesthesiology and Pain Medicine, Inha University College of Medicine, Incheon, Korea.
authors.forename: Hyun Kyoung
authors.initials: HK
authors.lastname: Lim
keywords: Ascending aorta; Cardiac arrest; Epinephrine; Gas embolism; Off-pump coronary artery bypass