Successful resuscitation after catastrophic carbon dioxide embolism during laparoscopic cholecystectomy

A 92-year-old female was scheduled for laparoscopic cholecystectomy. Following intraperitoneal carbon dioxide insufflation and removal of her gallbladder, the patient developed serious haemodynamic deterioration associated with a decrease of both end-tidal carbon dioxide concentration (ETCO2) and chest compliance. Carbon dioxide embolism was suspected and the diagnosis was confirmed by aspiration of 20 mL of foamy blood from the central venous line. The patient was successfully resuscitated after discontinuation of carbon dioxide insufflation and ventilation of the lungs with 100% oxygen. Carbon dioxide embolization must always be suspected during laparoscopic surgery whenever sudden haemodynamic deterioration associated with a decrease in ETCO2 and chest compliance occur.