Unexpected cardiovascular collapse from massive air embolism during endoscopic retrograde cholangiopancreatography

Acta Anaesthesiol Scand. 2010 Mar;54(3):385-8. doi: 10.1111/j.1399-6576.2009.02144.x. Epub 2009 Oct 29.


A 72 year-old woman with cholangiocarcinoma presented for endoscopic retrograde cholangio pancreatography (ERCP) for diagnostic intraductal endoscopy under GETA. During the technically difficult procedure the patient became suddenly hypoxic, hypotensive, bradycardic, and progressed to PEA code (ETCO2 5 mmHg). ACLS was initiated. Transesophageal echo demonstrated massive right heart air accumulation; abdominal X-Ray showed air filled bile ducts. Central access was obtained, a pulmonary artery catheter floated, and 30 ml of air aspirated from the RV. Within 5 minutes pulses returned; the patient was transferred to the ICU. MRI revealed two watershed infarcts in the right frontal lobe. The patient fully recovered and returned a month later for an uneventful ERCP.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Anesthesia, General
  • Carbon Dioxide / blood
  • Cardiopulmonary Resuscitation
  • Cholangiopancreatography, Endoscopic Retrograde / adverse effects*
  • Echocardiography, Transesophageal
  • Embolism, Air / complications*
  • Embolism, Air / etiology*
  • Female
  • Heart Arrest / etiology
  • Humans
  • Hypotension / etiology
  • Hypoxia / etiology
  • Intraoperative Complications / etiology*
  • Respiration, Artificial
  • Shock / etiology*


  • Carbon Dioxide