A case report of a carbon dioxide embolism caused by endoscopic vein harvesting during cardiac surgery -A case report-

Abstract

A carbon dioxide (CO2) embolism during endoscopic vein harvesting is a rare but potentially fatal complication. Early and accurate diagnosis is crucial for limiting the extent of the embolism and stabilizing the resulting cardiovascular compromise. We report a case of CO2 embolization during endoscopic vein harvesting. Transesophageal echocardiography was instrumental in the diagnosis and management of this patient by further improving the decision making process, which resulted in the best outcome. Mid-esophageal bicaval view is the best view to determine whether a CO2 embolism is coming from the upper or lower extremities.

Complications of CO2insufflation during endoscopic vein harvesting

“…CO 2 embolism may present within a spectrum of signs varying from minimal or none to sudden‐onset cardiogenic shock . It is frequently associated with unexplained hypercarbia and increased ETCO 2 .…”

“…Transesophageal echocardiography plays a vital role in prompt recognition of CO 2 embolism. The mid‐esophageal bicaval view provides excellent visualization of anatomic structures to identify gaseous embolism in the right heart …”

“…CO 2 embolism may present within a spectrum of signs varying from minimal or none 25 to sudden-onset cardiogenic shock. 24,32 It is frequently associated with unexplained hypercarbia and increased ETCO 2 . 33 Patients may present with signs suggestive of increased pulmonary resistance such as a rise in pulmonary artery pressure, RV strain, and rising central venous pressure.…”

“…Upon recognition of CO 2 embolism, insufflation must be interrupted immediately. Initial maneuvers include direct compression of the proximal venous axis at the level of the saphenofemoral junction 27,32 and adjustment of patient position to Trendelenburg with a leftward tilt. These modifications should isolate the embolus within the RV apex and prevent migration of air into the cerebral circulation in patients at risk for right-to-left shunting.…”

“…The mid-esophageal bicaval view provides excellent SUAREZ-PIERRE ET AL. | 785visualization of anatomic structures to identify gaseous embolism in the right heart 32.…”