Department of Anesthesiology and Pain Medicine, Inha University College of Medicine, Incheon, Korea.
Department of Anesthesiology and Pain Medicine, and Anesthesia and Pain Research institute, Yonsei University College of Medicine, Seoul, Korea.
Korean J Anesthesiol. 2013 Dec;65(6):562-4. doi: 10.4097/kjae.2013.65.6.562. Epub 2013 Dec 26.
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.
虽然在非体外循环冠状动脉旁路移植术中使用压缩气体（CO2）吹气机来辅助精确吻合是安全的，但气体栓塞进入右冠状动脉可能导致血液动力学崩溃。据报道，通过增加冠状动脉灌注压来支持清除气体的措施可成功恢复血液动力学稳定性。然而，右心室功能障碍和房室结缺血可能会阻碍血管活性药物的有效全身输送，即使在进行复苏措施（如直接心脏按摩）时也是如此。我们在此报告一例由右冠状动脉气体栓塞引起的心脏骤停病例，该病例无法通过心脏复苏恢复。当支持措施失败时，在开始体外循环之前，可以尝试直接向主动脉内注射肾上腺素以增加冠状动脉灌注压，在即使进行直接心脏按摩，从静脉侧全身输送药物也受到限制的情况下，这种方法可能具有救命作用。
