Gas embolism during endoscopic retrograde cholangiopancreatography: diagnosis and management.
Endoscopic retrograde cholangiopancreatography
air embolism
hyperbaric oxygen therapy
precordial Doppler ultrasound
transesophageal echocardiogram
Journal
Annals of gastroenterology
ISSN: 1108-7471
Titre abrégé: Ann Gastroenterol
Pays: Greece
ID NLM: 101121847
Informations de publication
Date de publication:
Historique:
received:
20
07
2018
accepted:
12
10
2018
entrez:
7
3
2019
pubmed:
7
3
2019
medline:
7
3
2019
Statut:
ppublish
Résumé
Air embolism is rarely diagnosed and is often fatal. The diagnosis is often not made in a timely manner given the rapid and severe clinical deterioration that often develops, frequently leading to cardiac arrest. Many patients are only diagnosed post-mortem. With the increasing use of endoscopic retrograde cholangiopancreatography, air embolism should be considered in the differential diagnosis in patients who experience sudden clinical deterioration during or immediately after the procedure. Clinical suspicion is key in the diagnosis and management of air embolism. Use of precordial Doppler ultrasound and transesophageal echocardiogram can aid in the diagnosis of air embolism. Once the diagnosis is made, supportive management of airway, breathing and circulation is pivotal. Advanced cardiac life support should be initiated when necessary. Fluid resuscitation and vasopressors can improve cardiac output. Hyperbaric oxygen therapy should be considered when possible in cases of suspected cerebral air embolism cases to improve neurological outcome. A multidisciplinary team approach and effective communication with experts, potentially including an anesthesiologist, cardiologist, intensivist, radiologist and surgeon, can improve the outcome in air embolism.
Identifiants
pubmed: 30837788
doi: 10.20524/aog.2018.0339
pii: AnnGastroenterol-32-156
pmc: PMC6394273
doi:
Types de publication
Journal Article
Review
Langues
eng
Pagination
156-167Déclaration de conflit d'intérêts
Conflict of Interest: None
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