Carbon dioxide embolism associated with transanal total mesorectal excision surgery: A report from the international registries

E. A. Dickson; M. Penna; C. Cunningham; F. M. Ratcliffe; J. Chantler; N. A. Crabtree; J. B. Tuynman; M. R. Albert; J. R. T. Monson; R. Hompes; W. Abdelmoaty; M. Adamina; F. Aigner; K. Alavi; B. Albers; Furajii H. Al; A. Allison; S. Eduardo; A. Araujo; G. Y. Apostolides; A. Arezzo; S. J. Arnold; K. Aryal; S. Ashamalla; S. Ashraf; V. Attaluri; R. Austin; G. Barugo-La; A. Beggs; H. J. Belgers; S. Bell; W. Bemelman; S. Berti; M. Biebl; J. Blondeel; B. Binky; Baloyiannis I. -N.; D. Bandyopadhyay; L. Boni; L. Bordeianou; B. Box; S. Boyce; W. Brokelman; C. J. Brown; L. Bruegger; C. Buchli; Buchs N. Christian; O. Bulut; C. Burt; A. Bursics; R. A. Cahill; Campana J. Pablo; M. Caricato; A. Caro-Tar-Rago; F. Casans; E. Cassinotti; A. Caycedo-Marulan-Da; S. A. Chadi; P. Chandrasinghe; S. Chaudhri; N. Chaumont; P. Chitsabesan; J. Coget; P. Collera; M. Coleman; E. D. Courtney; F. Dagbert; S. J. Dalton; G. Daniel; D. A. Clark; L. De-Drye; La Torre J. De; G. Dapri; S. P. Dayal; Chaisemartin C. De; De Lacy F. Borja; Delgado O. Blasco; Candido F. Di; Del Gobbo G. Diaz; Graaf E. J. R. De; P. Delrio; Pooter K. De; P. D'Hooge; P. Doornebosch; S. Duff; Jardin P. Du; K. E. Dzhumabaev; Edwards M. Tom; I. Egenvall; E. Espin; M. Eugenio; Egenvall M. -I.; Eriksen J. Ravn; A. E. Faerden; S. Faes; Fernandez V. Simo; A. Fichera; J. Fierens; K. Fierens; T. Forgan; N. Francis; J. Francombe; E. Francone; T. Francone; B. Gamage; Garcia J. A. Perez; Gecim I. Ethem; Geluwe B. Van; C. Gin-Gert; V. George; M. Gloeckler; I. Gogenur; A. Goulart; T. Grolich; E. Haas; U. Hameed; D. Hahnloser; A. Harikrishnan; G. Harris; I. Haunold; C. Hendrickse; T. Hendrickx; M. Heyns; J. Horwood; D. Huerga; M. Ito; A. Jarimba; H. K. M. Joeng; O. Jones; G. Jutten; Z. Kala; Y. Kita; J. Knol; Kochupapy R. Thengugal; W. Kneist; A. S. Y. Kok; M. Kusters; A. M. Lacy; M. Laka-Tos; R. Lal; Z. Lakkis; P. Leao; A. Lambrechts; L. Lee; B. Lelong; E. Leung; E. Lezoche; Liberman A. Sender; P. Lidder; Lima M. An-Drade; A. Loganathan; L. J. Lombana; L. Lorenzon; H. Loriz; M. Lukas; D. Lutrin; P. Mackey; Z. Z. Mamedli; S. Mansfield; P. Marcello; S. Marcoen; Marcos J. M. Romero; T. Marcy; S. Marecik; J. Marks; P. Marsanic; A. Mattacheo; D. Maun; D. May; J. A. Maykel; D. McArthur; I. Mccallum; K. McCarthy; E. C. McLemore; Sil-Viera Mendes C. Ramon; E. Messaris; A. Michalopoulos; S. Mikalauskas; A. Miles; M. Millan; S. Mills; D. Miskovic; I. Montroni; E. Moore; T. Moore; S. Mori; M. Morino; A. Muratore; V. Mutafchiyski; A. Myers; Nieuwenhove Y. Van; Y. Nishizawa; P. Ng; Nolan G. John; V. Obias; A. Ochsner; Oh J. Hwan; T. Onghena; S. Oommen; B. A. Orkin; K. Osman; S. Ouro; Y. Panis; T. Papavramidis; Papen M. Von; G. Papp; I. Paquette; M. T. Paraoan; J. P. Paredes; C. Pastor; P. R. L. Pattyn; Perdawood S. Karim; Pei C. F. Wan; J. Piehslinger; D. Penchev; Perez R. Oliva; Roberto Persiani; F. Pfeffer; Phang P. Terry; V. Pokela; A. Picchetto; E. Poskus; D. Prieto; F. A. Que-Reshy; S. Ramcharan; S. Rauch; D. Rega; J. C. Reyes; F. Ris; Rivilla S. Delgado; Rockall T. Alexander; P. Roquete; G. Rossi; G. Ruffo; Sakai Y. -S.; D. Sands; Juliao G. P. Sao; A. Scala; D. Scala; Schwarz L. Estevez; Seid V. Edmond; G. Seitinger; I. A. Shaikh; A. Sharma; C. Siet-Ses; B. Singh; Sjo O. Helmer; Sohn D. Kyung; C. Sora-Via; M. N. Sosef; A. Spinelli; C. Speakman; S. Steele; V. Stephan; A. R. L. Stevenson; P. Stotland; P. Studer; S. Strypstein; P. Sylla; A. Szyszkowitz; A. Talwar; P. Tanis; P. Tejedor; Teso E. Pastor; J. Tognelli; J. Torkington; P. Tschann; Tuech J. -J.; A. Tuerler; G. Tzovaras; G. Ugolini; F. Vallribera; F. Vansteenkiste; E. Vangenechten; E. G. G. Verdaasdonk; N. Vilela; B. Walter; O. J. Warren; T. Visser; S. Warrier; M. Warner; J. Waru-Savitarne; M. H. Whiteford; Wik T. Andreas; Witzig J. -A.; T. Wolff; A. M. Wolthuis; G. Wynn

doi:10.1097/DCR.0000000000001410

Carbon dioxide embolism associated with transanal total mesorectal excision surgery: A report from the international registries

E. A. Dickson, M. Penna, C. Cunningham, F. M. Ratcliffe, J. Chantler, N. A. Crabtree, J. B. Tuynman, M. R. Albert, J. R. T. Monson, R. Hompes^*, W. Abdelmoaty, M. Adamina, F. Aigner, K. Alavi, B. Albers, Furajii H. Al, A. Allison, S. Eduardo, A. Araujo, G. Y. ApostolidesA. Arezzo, S. J. Arnold, K. Aryal, S. Ashamalla, S. Ashraf, V. Attaluri, R. Austin, G. Barugo-La, A. Beggs, H. J. Belgers, S. Bell, W. Bemelman, S. Berti, M. Biebl, J. Blondeel, B. Binky, Baloyiannis I. -N., D. Bandyopadhyay, L. Boni, L. Bordeianou, B. Box, S. Boyce, W. Brokelman, C. J. Brown, L. Bruegger, C. Buchli, Buchs N. Christian, O. Bulut, C. Burt, A. Bursics, R. A. Cahill, Campana J. Pablo, M. Caricato, A. Caro-Tar-Rago, F. Casans, E. Cassinotti, A. Caycedo-Marulan-Da, S. A. Chadi, P. Chandrasinghe, S. Chaudhri, N. Chaumont, P. Chitsabesan, J. Coget, P. Collera, M. Coleman, E. D. Courtney, F. Dagbert, S. J. Dalton, G. Daniel, D. A. Clark, L. De-Drye, La Torre J. De, G. Dapri, S. P. Dayal, Chaisemartin C. De, De Lacy F. Borja, Delgado O. Blasco, Candido F. Di, Del Gobbo G. Diaz, Graaf E. J. R. De, P. Delrio, Pooter K. De, P. D'Hooge, P. Doornebosch, S. Duff, Jardin P. Du, K. E. Dzhumabaev, Edwards M. Tom, I. Egenvall, E. Espin, M. Eugenio, Egenvall M. -I., Eriksen J. Ravn, A. E. Faerden, S. Faes, Fernandez V. Simo, A. Fichera, J. Fierens, K. Fierens, T. Forgan, N. Francis, J. Francombe, E. Francone, T. Francone, B. Gamage, Garcia J. A. Perez, Gecim I. Ethem, Geluwe B. Van, C. Gin-Gert, V. George, M. Gloeckler, I. Gogenur, A. Goulart, T. Grolich, E. Haas, U. Hameed, D. Hahnloser, A. Harikrishnan, G. Harris, I. Haunold, C. Hendrickse, T. Hendrickx, M. Heyns, J. Horwood, D. Huerga, M. Ito, A. Jarimba, H. K. M. Joeng, O. Jones, G. Jutten, Z. Kala, Y. Kita, J. Knol, Kochupapy R. Thengugal, W. Kneist, A. S. Y. Kok, M. Kusters, A. M. Lacy, M. Laka-Tos, R. Lal, Z. Lakkis, P. Leao, A. Lambrechts, L. Lee, B. Lelong, E. Leung, E. Lezoche, Liberman A. Sender, P. Lidder, Lima M. An-Drade, A. Loganathan, L. J. Lombana, L. Lorenzon, H. Loriz, M. Lukas, D. Lutrin, P. Mackey, Z. Z. Mamedli, S. Mansfield, P. Marcello, S. Marcoen, Marcos J. M. Romero, T. Marcy, S. Marecik, J. Marks, P. Marsanic, A. Mattacheo, D. Maun, D. May, J. A. Maykel, D. McArthur, I. Mccallum, K. McCarthy, E. C. McLemore, Sil-Viera Mendes C. Ramon, E. Messaris, A. Michalopoulos, S. Mikalauskas, A. Miles, M. Millan, S. Mills, D. Miskovic, I. Montroni, E. Moore, T. Moore, S. Mori, M. Morino, A. Muratore, V. Mutafchiyski, A. Myers, Nieuwenhove Y. Van, Y. Nishizawa, P. Ng, Nolan G. John, V. Obias, A. Ochsner, Oh J. Hwan, T. Onghena, S. Oommen, B. A. Orkin, K. Osman, S. Ouro, Y. Panis, T. Papavramidis, Papen M. Von, G. Papp, I. Paquette, M. T. Paraoan, J. P. Paredes, C. Pastor, P. R. L. Pattyn, Perdawood S. Karim, Pei C. F. Wan, J. Piehslinger, D. Penchev, Perez R. Oliva, Roberto Persiani, F. Pfeffer, Phang P. Terry, V. Pokela, A. Picchetto, E. Poskus, D. Prieto, F. A. Que-Reshy, S. Ramcharan, S. Rauch, D. Rega, J. C. Reyes, F. Ris, Rivilla S. Delgado, Rockall T. Alexander, P. Roquete, G. Rossi, G. Ruffo, Sakai Y. -S., D. Sands, Juliao G. P. Sao, A. Scala, D. Scala, Schwarz L. Estevez, Seid V. Edmond, G. Seitinger, I. A. Shaikh, A. Sharma, C. Siet-Ses, B. Singh, Sjo O. Helmer, Sohn D. Kyung, C. Sora-Via, M. N. Sosef, A. Spinelli, C. Speakman, S. Steele, V. Stephan, A. R. L. Stevenson, P. Stotland, P. Studer, S. Strypstein, P. Sylla, A. Szyszkowitz, A. Talwar, P. Tanis, P. Tejedor, Teso E. Pastor, J. Tognelli, J. Torkington, P. Tschann, Tuech J. -J., A. Tuerler, G. Tzovaras, G. Ugolini, F. Vallribera, F. Vansteenkiste, E. Vangenechten, E. G. G. Verdaasdonk, N. Vilela, B. Walter, O. J. Warren, T. Visser, S. Warrier, M. Warner, J. Waru-Savitarne, M. H. Whiteford, Wik T. Andreas, Witzig J. -A., T. Wolff, A. M. Wolthuis, G. Wynn

^*Autore corrispondente per questo lavoro

Risultato della ricerca: Contributo in rivista › Articolo

24 Citazioni (Scopus)

Abstract

BACKGROUND: Carbon dioxide embolus has been reported as a rare but clinically important risk associated with transanal total mesorectal excision surgery. To date, there exists limited data describing the incidence, risk factors, and management of carbon dioxide embolus in transanal total mesorectal excision. OBJECTIVE: This study aimed to obtain data from the transanal total mesorectal excision registries to identify trends and potential risk factors for carbon dioxide embolus specific to this surgical technique. DESIGN: Contributors to both the LOREC and OSTRiCh transanal total mesorectal excision registries were invited to report their incidence of carbon dioxide embolus. Case report forms were collected detailing the patient-specific and technical factors of each event. SETTINGS: The study was conducted at the collaborating centers from the international transanal total mesorectal excision registries. MAIN OUTCOME MEASURES: Characteristics and outcomes of patients with carbon dioxide embolus associated with transanal mesorectal excision were measured. RESULTS: Twenty-five cases were reported. The incidence of carbon dioxide embolus during transanal total mesorectal excision is estimated to be ≈0.4% (25/6375 cases). A fall in end tidal carbon dioxide was noted as the initial feature in 22 cases, with 13 (52%) developing signs of hemodynamic compromise. All of the events occurred in the transanal component of dissection, with mean (range) insufflation pressures of 15 mm Hg (12-20 mm Hg). Patients were predominantly (68%) in a Trendelenburg position, between 30° and 45°. Venous bleeding was reported in 20 cases at the time of carbon dioxide embolus, with periprostatic veins documented as the most common site (40%). After carbon dioxide embolus, 84% of cases were completed after hemodynamic stabilization. Two patients required cardiopulmonary resuscitation because of cardiovascular collapse. There were no deaths. LIMITATIONS: This is a retrospective study surveying reported outcomes by surgeons and anesthetists. CONCLUSIONS: Surgeons undertaking transanal total mesorectal excision must be aware of the possibility of carbon dioxide embolus and its potential risk factors, including venous bleeding (wrong plane surgery), high insufflation pressures, and patient positioning. Prompt recognition and management can limit the clinical impact of such events. See Video Abstract at http://links. lww.com/DCR/A961.

Lingua originale	Inglese
pagine (da-a)	794-801
Numero di pagine	8
Rivista	Diseases of the Colon and Rectum
Volume	62
Numero di pubblicazione	7
DOI	https://doi.org/10.1097/DCR.0000000000001410
Stato di pubblicazione	Pubblicato - 2019

All Science Journal Classification (ASJC) codes

Gastroenterologia

Keywords

80 and over
Adult
Aged
Air
Carbon Dioxide
Carbon dioxide embolus
Embolism
Female
Hemorrhage
Humans
Insufflation
Internationality
Intraoperative Complications
Male
Middle Aged
Patient Positioning
Postoperative Care
Rectal surgery
Rectum
Registries
Registry report
Retrospective Studies
Risk Factors
Transanal
Transanal Endoscopic Surgery
Transanal total mesorectal excision
Veins

Accesso al documento

10.1097/DCR.0000000000001410

Altri file e collegamenti

Cita questo

Dickson, E. A., Penna, M., Cunningham, C., Ratcliffe, F. M., Chantler, J., Crabtree, N. A., Tuynman, J. B., Albert, M. R., Monson, J. R. T., Hompes, R., Abdelmoaty, W., Adamina, M., Aigner, F., Alavi, K., Albers, B., Al, F. H., Allison, A., Eduardo, S., Araujo, A., ... Wynn, G. (2019). Carbon dioxide embolism associated with transanal total mesorectal excision surgery: A report from the international registries. Diseases of the Colon and Rectum, 62(7), 794-801. https://doi.org/10.1097/DCR.0000000000001410

@article{122563a74d624f96b8ce498502133918,

title = "Carbon dioxide embolism associated with transanal total mesorectal excision surgery: A report from the international registries",

abstract = "BACKGROUND: Carbon dioxide embolus has been reported as a rare but clinically important risk associated with transanal total mesorectal excision surgery. To date, there exists limited data describing the incidence, risk factors, and management of carbon dioxide embolus in transanal total mesorectal excision. OBJECTIVE: This study aimed to obtain data from the transanal total mesorectal excision registries to identify trends and potential risk factors for carbon dioxide embolus specific to this surgical technique. DESIGN: Contributors to both the LOREC and OSTRiCh transanal total mesorectal excision registries were invited to report their incidence of carbon dioxide embolus. Case report forms were collected detailing the patient-specific and technical factors of each event. SETTINGS: The study was conducted at the collaborating centers from the international transanal total mesorectal excision registries. MAIN OUTCOME MEASURES: Characteristics and outcomes of patients with carbon dioxide embolus associated with transanal mesorectal excision were measured. RESULTS: Twenty-five cases were reported. The incidence of carbon dioxide embolus during transanal total mesorectal excision is estimated to be ≈0.4% (25/6375 cases). A fall in end tidal carbon dioxide was noted as the initial feature in 22 cases, with 13 (52%) developing signs of hemodynamic compromise. All of the events occurred in the transanal component of dissection, with mean (range) insufflation pressures of 15 mm Hg (12-20 mm Hg). Patients were predominantly (68%) in a Trendelenburg position, between 30° and 45°. Venous bleeding was reported in 20 cases at the time of carbon dioxide embolus, with periprostatic veins documented as the most common site (40%). After carbon dioxide embolus, 84% of cases were completed after hemodynamic stabilization. Two patients required cardiopulmonary resuscitation because of cardiovascular collapse. There were no deaths. LIMITATIONS: This is a retrospective study surveying reported outcomes by surgeons and anesthetists. CONCLUSIONS: Surgeons undertaking transanal total mesorectal excision must be aware of the possibility of carbon dioxide embolus and its potential risk factors, including venous bleeding (wrong plane surgery), high insufflation pressures, and patient positioning. Prompt recognition and management can limit the clinical impact of such events. See Video Abstract at http://links. lww.com/DCR/A961.",

keywords = "80 and over, Adult, Aged, Air, Carbon Dioxide, Carbon dioxide embolus, Embolism, Female, Hemorrhage, Humans, Insufflation, Internationality, Intraoperative Complications, Male, Middle Aged, Patient Positioning, Postoperative Care, Rectal surgery, Rectum, Registries, Registry report, Retrospective Studies, Risk Factors, Transanal, Transanal Endoscopic Surgery, Transanal total mesorectal excision, Veins, 80 and over, Adult, Aged, Air, Carbon Dioxide, Carbon dioxide embolus, Embolism, Female, Hemorrhage, Humans, Insufflation, Internationality, Intraoperative Complications, Male, Middle Aged, Patient Positioning, Postoperative Care, Rectal surgery, Rectum, Registries, Registry report, Retrospective Studies, Risk Factors, Transanal, Transanal Endoscopic Surgery, Transanal total mesorectal excision, Veins",

author = "Dickson, {E. A.} and M. Penna and C. Cunningham and Ratcliffe, {F. M.} and J. Chantler and Crabtree, {N. A.} and Tuynman, {J. B.} and Albert, {M. R.} and Monson, {J. R. T.} and R. Hompes and W. Abdelmoaty and M. Adamina and F. Aigner and K. Alavi and B. Albers and Al, {Furajii H.} and A. Allison and S. Eduardo and A. Araujo and Apostolides, {G. Y.} and A. Arezzo and Arnold, {S. J.} and K. Aryal and S. Ashamalla and S. Ashraf and V. Attaluri and R. Austin and G. Barugo-La and A. Beggs and Belgers, {H. J.} and S. Bell and W. Bemelman and S. Berti and M. Biebl and J. Blondeel and B. Binky and -N., {Baloyiannis I.} and D. Bandyopadhyay and L. Boni and L. Bordeianou and B. Box and S. Boyce and W. Brokelman and Brown, {C. J.} and L. Bruegger and C. Buchli and Christian, {Buchs N.} and O. Bulut and C. Burt and A. Bursics and Cahill, {R. A.} and Pablo, {Campana J.} and M. Caricato and A. Caro-Tar-Rago and F. Casans and E. Cassinotti and A. Caycedo-Marulan-Da and Chadi, {S. A.} and P. Chandrasinghe and S. Chaudhri and N. Chaumont and P. Chitsabesan and J. Coget and P. Collera and M. Coleman and Courtney, {E. D.} and F. Dagbert and Dalton, {S. J.} and G. Daniel and Clark, {D. A.} and L. De-Drye and De, {La Torre J.} and G. Dapri and Dayal, {S. P.} and De, {Chaisemartin C.} and Borja, {De Lacy F.} and Blasco, {Delgado O.} and Di, {Candido F.} and Diaz, {Del Gobbo G.} and De, {Graaf E. J. R.} and P. Delrio and De, {Pooter K.} and P. D'Hooge and P. Doornebosch and S. Duff and Du, {Jardin P.} and Dzhumabaev, {K. E.} and Tom, {Edwards M.} and I. Egenvall and E. Espin and M. Eugenio and -I., {Egenvall M.} and Ravn, {Eriksen J.} and Faerden, {A. E.} and S. Faes and Simo, {Fernandez V.} and A. Fichera and J. Fierens and K. Fierens and T. Forgan and N. Francis and J. Francombe and E. Francone and T. Francone and B. Gamage and Perez, {Garcia J. A.} and Ethem, {Gecim I.} and Van, {Geluwe B.} and C. Gin-Gert and V. George and M. Gloeckler and I. Gogenur and A. Goulart and T. Grolich and E. Haas and U. Hameed and D. Hahnloser and A. Harikrishnan and G. Harris and I. Haunold and C. Hendrickse and T. Hendrickx and M. Heyns and J. Horwood and D. Huerga and M. Ito and A. Jarimba and Joeng, {H. K. M.} and O. Jones and G. Jutten and Z. Kala and Y. Kita and J. Knol and Thengugal, {Kochupapy R.} and W. Kneist and Kok, {A. S. Y.} and M. Kusters and Lacy, {A. M.} and M. Laka-Tos and R. Lal and Z. Lakkis and P. Leao and A. Lambrechts and L. Lee and B. Lelong and E. Leung and E. Lezoche and Sender, {Liberman A.} and P. Lidder and An-Drade, {Lima M.} and A. Loganathan and Lombana, {L. J.} and L. Lorenzon and H. Loriz and M. Lukas and D. Lutrin and P. Mackey and Mamedli, {Z. Z.} and S. Mansfield and P. Marcello and S. Marcoen and Romero, {Marcos J. M.} and T. Marcy and S. Marecik and J. Marks and P. Marsanic and A. Mattacheo and D. Maun and D. May and Maykel, {J. A.} and D. McArthur and I. Mccallum and K. McCarthy and McLemore, {E. C.} and Ramon, {Sil-Viera Mendes C.} and E. Messaris and A. Michalopoulos and S. Mikalauskas and A. Miles and M. Millan and S. Mills and D. Miskovic and I. Montroni and E. Moore and T. Moore and S. Mori and M. Morino and A. Muratore and V. Mutafchiyski and A. Myers and Van, {Nieuwenhove Y.} and Y. Nishizawa and P. Ng and John, {Nolan G.} and V. Obias and A. Ochsner and Hwan, {Oh J.} and T. Onghena and S. Oommen and Orkin, {B. A.} and K. Osman and S. Ouro and Y. Panis and T. Papavramidis and Von, {Papen M.} and G. Papp and I. Paquette and Paraoan, {M. T.} and Paredes, {J. P.} and C. Pastor and Pattyn, {P. R. L.} and Karim, {Perdawood S.} and Wan, {Pei C. F.} and J. Piehslinger and D. Penchev and Oliva, {Perez R.} and Roberto Persiani and F. Pfeffer and Terry, {Phang P.} and V. Pokela and A. Picchetto and E. Poskus and D. Prieto and Que-Reshy, {F. A.} and S. Ramcharan and S. Rauch and D. Rega and Reyes, {J. C.} and F. Ris and Delgado, {Rivilla S.} and Alexander, {Rockall T.} and P. Roquete and G. Rossi and G. Ruffo and -S., {Sakai Y.} and D. Sands and Sao, {Juliao G. P.} and A. Scala and D. Scala and Estevez, {Schwarz L.} and Edmond, {Seid V.} and G. Seitinger and Shaikh, {I. A.} and A. Sharma and C. Siet-Ses and B. Singh and Helmer, {Sjo O.} and Kyung, {Sohn D.} and C. Sora-Via and Sosef, {M. N.} and A. Spinelli and C. Speakman and S. Steele and V. Stephan and Stevenson, {A. R. L.} and P. Stotland and P. Studer and S. Strypstein and P. Sylla and A. Szyszkowitz and A. Talwar and P. Tanis and P. Tejedor and Pastor, {Teso E.} and J. Tognelli and J. Torkington and P. Tschann and -J., {Tuech J.} and A. Tuerler and G. Tzovaras and G. Ugolini and F. Vallribera and F. Vansteenkiste and E. Vangenechten and Verdaasdonk, {E. G. G.} and N. Vilela and B. Walter and Warren, {O. J.} and T. Visser and S. Warrier and M. Warner and J. Waru-Savitarne and Whiteford, {M. H.} and Andreas, {Wik T.} and -A., {Witzig J.} and T. Wolff and Wolthuis, {A. M.} and G. Wynn",

year = "2019",

doi = "10.1097/DCR.0000000000001410",

language = "English",

volume = "62",

pages = "794--801",

journal = "Diseases of the Colon and Rectum",

issn = "0012-3706",

publisher = "Lippincott Williams and Wilkins",

number = "7",

}

Dickson, EA, Penna, M, Cunningham, C, Ratcliffe, FM, Chantler, J, Crabtree, NA, Tuynman, JB, Albert, MR, Monson, JRT, Hompes, R, Abdelmoaty, W, Adamina, M, Aigner, F, Alavi, K, Albers, B, Al, FH, Allison, A, Eduardo, S, Araujo, A, Apostolides, GY, Arezzo, A, Arnold, SJ, Aryal, K, Ashamalla, S, Ashraf, S, Attaluri, V, Austin, R, Barugo-La, G, Beggs, A, Belgers, HJ, Bell, S, Bemelman, W, Berti, S, Biebl, M, Blondeel, J, Binky, B, -N., BI, Bandyopadhyay, D, Boni, L, Bordeianou, L, Box, B, Boyce, S, Brokelman, W, Brown, CJ, Bruegger, L, Buchli, C, Christian, BN, Bulut, O, Burt, C, Bursics, A, Cahill, RA, Pablo, CJ, Caricato, M, Caro-Tar-Rago, A, Casans, F, Cassinotti, E, Caycedo-Marulan-Da, A, Chadi, SA, Chandrasinghe, P, Chaudhri, S, Chaumont, N, Chitsabesan, P, Coget, J, Collera, P, Coleman, M, Courtney, ED, Dagbert, F, Dalton, SJ, Daniel, G, Clark, DA, De-Drye, L, De, LTJ, Dapri, G, Dayal, SP, De, CC, Borja, DLF, Blasco, DO, Di, CF, Diaz, DGG, De, GEJR, Delrio, P, De, PK, D'Hooge, P, Doornebosch, P, Duff, S, Du, JP, Dzhumabaev, KE, Tom, EM, Egenvall, I, Espin, E, Eugenio, M, -I., EM, Ravn, EJ, Faerden, AE, Faes, S, Simo, FV, Fichera, A, Fierens, J, Fierens, K, Forgan, T, Francis, N, Francombe, J, Francone, E, Francone, T, Gamage, B, Perez, GJA, Ethem, GI, Van, GB, Gin-Gert, C, George, V, Gloeckler, M, Gogenur, I, Goulart, A, Grolich, T, Haas, E, Hameed, U, Hahnloser, D, Harikrishnan, A, Harris, G, Haunold, I, Hendrickse, C, Hendrickx, T, Heyns, M, Horwood, J, Huerga, D, Ito, M, Jarimba, A, Joeng, HKM, Jones, O, Jutten, G, Kala, Z, Kita, Y, Knol, J, Thengugal, KR, Kneist, W, Kok, ASY, Kusters, M, Lacy, AM, Laka-Tos, M, Lal, R, Lakkis, Z, Leao, P, Lambrechts, A, Lee, L, Lelong, B, Leung, E, Lezoche, E, Sender, LA, Lidder, P, An-Drade, LM, Loganathan, A, Lombana, LJ, Lorenzon, L, Loriz, H, Lukas, M, Lutrin, D, Mackey, P, Mamedli, ZZ, Mansfield, S, Marcello, P, Marcoen, S, Romero, MJM, Marcy, T, Marecik, S, Marks, J, Marsanic, P, Mattacheo, A, Maun, D, May, D, Maykel, JA, McArthur, D, Mccallum, I, McCarthy, K, McLemore, EC, Ramon, S-VMC, Messaris, E, Michalopoulos, A, Mikalauskas, S, Miles, A, Millan, M, Mills, S, Miskovic, D, Montroni, I, Moore, E, Moore, T, Mori, S, Morino, M, Muratore, A, Mutafchiyski, V, Myers, A, Van, NY, Nishizawa, Y, Ng, P, John, NG, Obias, V, Ochsner, A, Hwan, OJ, Onghena, T, Oommen, S, Orkin, BA, Osman, K, Ouro, S, Panis, Y, Papavramidis, T, Von, PM, Papp, G, Paquette, I, Paraoan, MT, Paredes, JP, Pastor, C, Pattyn, PRL, Karim, PS, Wan, PCF, Piehslinger, J, Penchev, D, Oliva, PR, Persiani, R, Pfeffer, F, Terry, PP, Pokela, V, Picchetto, A, Poskus, E, Prieto, D, Que-Reshy, FA, Ramcharan, S, Rauch, S, Rega, D, Reyes, JC, Ris, F, Delgado, RS, Alexander, RT, Roquete, P, Rossi, G, Ruffo, G, -S., SY, Sands, D, Sao, JGP, Scala, A, Scala, D, Estevez, SL, Edmond, SV, Seitinger, G, Shaikh, IA, Sharma, A, Siet-Ses, C, Singh, B, Helmer, SO, Kyung, SD, Sora-Via, C, Sosef, MN, Spinelli, A, Speakman, C, Steele, S, Stephan, V, Stevenson, ARL, Stotland, P, Studer, P, Strypstein, S, Sylla, P, Szyszkowitz, A, Talwar, A, Tanis, P, Tejedor, P, Pastor, TE, Tognelli, J, Torkington, J, Tschann, P, -J., TJ, Tuerler, A, Tzovaras, G, Ugolini, G, Vallribera, F, Vansteenkiste, F, Vangenechten, E, Verdaasdonk, EGG, Vilela, N, Walter, B, Warren, OJ, Visser, T, Warrier, S, Warner, M, Waru-Savitarne, J, Whiteford, MH, Andreas, WT, -A., WJ, Wolff, T, Wolthuis, AM & Wynn, G 2019, 'Carbon dioxide embolism associated with transanal total mesorectal excision surgery: A report from the international registries', Diseases of the Colon and Rectum, vol. 62, n. 7, pagg. 794-801. https://doi.org/10.1097/DCR.0000000000001410

TY - JOUR

T1 - Carbon dioxide embolism associated with transanal total mesorectal excision surgery: A report from the international registries

AU - Dickson, E. A.

AU - Penna, M.

AU - Cunningham, C.

AU - Ratcliffe, F. M.

AU - Chantler, J.

AU - Crabtree, N. A.

AU - Tuynman, J. B.

AU - Albert, M. R.

AU - Monson, J. R. T.

AU - Hompes, R.

AU - Abdelmoaty, W.

AU - Adamina, M.

AU - Aigner, F.

AU - Alavi, K.

AU - Albers, B.

AU - Al, Furajii H.

AU - Allison, A.

AU - Eduardo, S.

AU - Araujo, A.

AU - Apostolides, G. Y.

AU - Arezzo, A.

AU - Arnold, S. J.

AU - Aryal, K.

AU - Ashamalla, S.

AU - Ashraf, S.

AU - Attaluri, V.

AU - Austin, R.

AU - Barugo-La, G.

AU - Beggs, A.

AU - Belgers, H. J.

AU - Bell, S.

AU - Bemelman, W.

AU - Berti, S.

AU - Biebl, M.

AU - Blondeel, J.

AU - Binky, B.

AU - -N., Baloyiannis I.

AU - Bandyopadhyay, D.

AU - Boni, L.

AU - Bordeianou, L.

AU - Box, B.

AU - Boyce, S.

AU - Brokelman, W.

AU - Brown, C. J.

AU - Bruegger, L.

AU - Buchli, C.

AU - Christian, Buchs N.

AU - Bulut, O.

AU - Burt, C.

AU - Bursics, A.

AU - Cahill, R. A.

AU - Pablo, Campana J.

AU - Caricato, M.

AU - Caro-Tar-Rago, A.

AU - Casans, F.

AU - Cassinotti, E.

AU - Caycedo-Marulan-Da, A.

AU - Chadi, S. A.

AU - Chandrasinghe, P.

AU - Chaudhri, S.

AU - Chaumont, N.

AU - Chitsabesan, P.

AU - Coget, J.

AU - Collera, P.

AU - Coleman, M.

AU - Courtney, E. D.

AU - Dagbert, F.

AU - Dalton, S. J.

AU - Daniel, G.

AU - Clark, D. A.

AU - De-Drye, L.

AU - De, La Torre J.

AU - Dapri, G.

AU - Dayal, S. P.

AU - De, Chaisemartin C.

AU - Borja, De Lacy F.

AU - Blasco, Delgado O.

AU - Di, Candido F.

AU - Diaz, Del Gobbo G.

AU - De, Graaf E. J. R.

AU - Delrio, P.

AU - De, Pooter K.

AU - D'Hooge, P.

AU - Doornebosch, P.

AU - Duff, S.

AU - Du, Jardin P.

AU - Dzhumabaev, K. E.

AU - Tom, Edwards M.

AU - Egenvall, I.

AU - Espin, E.

AU - Eugenio, M.

AU - -I., Egenvall M.

AU - Ravn, Eriksen J.

AU - Faerden, A. E.

AU - Faes, S.

AU - Simo, Fernandez V.

AU - Fichera, A.

AU - Fierens, J.

AU - Fierens, K.

AU - Forgan, T.

AU - Francis, N.

AU - Francombe, J.

AU - Francone, E.

AU - Francone, T.

AU - Gamage, B.

AU - Perez, Garcia J. A.

AU - Ethem, Gecim I.

AU - Van, Geluwe B.

AU - Gin-Gert, C.

AU - George, V.

AU - Gloeckler, M.

AU - Gogenur, I.

AU - Goulart, A.

AU - Grolich, T.

AU - Haas, E.

AU - Hameed, U.

AU - Hahnloser, D.

AU - Harikrishnan, A.

AU - Harris, G.

AU - Haunold, I.

AU - Hendrickse, C.

AU - Hendrickx, T.

AU - Heyns, M.

AU - Horwood, J.

AU - Huerga, D.

AU - Ito, M.

AU - Jarimba, A.

AU - Joeng, H. K. M.

AU - Jones, O.

AU - Jutten, G.

AU - Kala, Z.

AU - Kita, Y.

AU - Knol, J.

AU - Thengugal, Kochupapy R.

AU - Kneist, W.

AU - Kok, A. S. Y.

AU - Kusters, M.

AU - Lacy, A. M.

AU - Laka-Tos, M.

AU - Lal, R.

AU - Lakkis, Z.

AU - Leao, P.

AU - Lambrechts, A.

AU - Lee, L.

AU - Lelong, B.

AU - Leung, E.

AU - Lezoche, E.

AU - Sender, Liberman A.

AU - Lidder, P.

AU - An-Drade, Lima M.

AU - Loganathan, A.

AU - Lombana, L. J.

AU - Lorenzon, L.

AU - Loriz, H.

AU - Lukas, M.

AU - Lutrin, D.

AU - Mackey, P.

AU - Mamedli, Z. Z.

AU - Mansfield, S.

AU - Marcello, P.

AU - Marcoen, S.

AU - Romero, Marcos J. M.

AU - Marcy, T.

AU - Marecik, S.

AU - Marks, J.

AU - Marsanic, P.

AU - Mattacheo, A.

AU - Maun, D.

AU - May, D.

AU - Maykel, J. A.

AU - McArthur, D.

AU - Mccallum, I.

AU - McCarthy, K.

AU - McLemore, E. C.

AU - Ramon, Sil-Viera Mendes C.

AU - Messaris, E.

AU - Michalopoulos, A.

AU - Mikalauskas, S.

AU - Miles, A.

AU - Millan, M.

AU - Mills, S.

AU - Miskovic, D.

AU - Montroni, I.

AU - Moore, E.

AU - Moore, T.

AU - Mori, S.

AU - Morino, M.

AU - Muratore, A.

AU - Mutafchiyski, V.

AU - Myers, A.

AU - Van, Nieuwenhove Y.

AU - Nishizawa, Y.

AU - Ng, P.

AU - John, Nolan G.

AU - Obias, V.

AU - Ochsner, A.

AU - Hwan, Oh J.

AU - Onghena, T.

AU - Oommen, S.

AU - Orkin, B. A.

AU - Osman, K.

AU - Ouro, S.

AU - Panis, Y.

AU - Papavramidis, T.

AU - Von, Papen M.

AU - Papp, G.

AU - Paquette, I.

AU - Paraoan, M. T.

AU - Paredes, J. P.

AU - Pastor, C.

AU - Pattyn, P. R. L.

AU - Karim, Perdawood S.

AU - Wan, Pei C. F.

AU - Piehslinger, J.

AU - Penchev, D.

AU - Oliva, Perez R.

AU - Persiani, Roberto

AU - Pfeffer, F.

AU - Terry, Phang P.

AU - Pokela, V.

AU - Picchetto, A.

AU - Poskus, E.

AU - Prieto, D.

AU - Que-Reshy, F. A.

AU - Ramcharan, S.

AU - Rauch, S.

AU - Rega, D.

AU - Reyes, J. C.

AU - Ris, F.

AU - Delgado, Rivilla S.

AU - Alexander, Rockall T.

AU - Roquete, P.

AU - Rossi, G.

AU - Ruffo, G.

AU - -S., Sakai Y.

AU - Sands, D.

AU - Sao, Juliao G. P.

AU - Scala, A.

AU - Scala, D.

AU - Estevez, Schwarz L.

AU - Edmond, Seid V.

AU - Seitinger, G.

AU - Shaikh, I. A.

AU - Sharma, A.

AU - Siet-Ses, C.

AU - Singh, B.

AU - Helmer, Sjo O.

AU - Kyung, Sohn D.

AU - Sora-Via, C.

AU - Sosef, M. N.

AU - Spinelli, A.

AU - Speakman, C.

AU - Steele, S.

AU - Stephan, V.

AU - Stevenson, A. R. L.

AU - Stotland, P.

AU - Studer, P.

AU - Strypstein, S.

AU - Sylla, P.

AU - Szyszkowitz, A.

AU - Talwar, A.

AU - Tanis, P.

AU - Tejedor, P.

AU - Pastor, Teso E.

AU - Tognelli, J.

AU - Torkington, J.

AU - Tschann, P.

AU - -J., Tuech J.

AU - Tuerler, A.

AU - Tzovaras, G.

AU - Ugolini, G.

AU - Vallribera, F.

AU - Vansteenkiste, F.

AU - Vangenechten, E.

AU - Verdaasdonk, E. G. G.

AU - Vilela, N.

AU - Walter, B.

AU - Warren, O. J.

AU - Visser, T.

AU - Warrier, S.

AU - Warner, M.

AU - Waru-Savitarne, J.

AU - Whiteford, M. H.

AU - Andreas, Wik T.

AU - -A., Witzig J.

AU - Wolff, T.

AU - Wolthuis, A. M.

AU - Wynn, G.

PY - 2019

Y1 - 2019

N2 - BACKGROUND: Carbon dioxide embolus has been reported as a rare but clinically important risk associated with transanal total mesorectal excision surgery. To date, there exists limited data describing the incidence, risk factors, and management of carbon dioxide embolus in transanal total mesorectal excision. OBJECTIVE: This study aimed to obtain data from the transanal total mesorectal excision registries to identify trends and potential risk factors for carbon dioxide embolus specific to this surgical technique. DESIGN: Contributors to both the LOREC and OSTRiCh transanal total mesorectal excision registries were invited to report their incidence of carbon dioxide embolus. Case report forms were collected detailing the patient-specific and technical factors of each event. SETTINGS: The study was conducted at the collaborating centers from the international transanal total mesorectal excision registries. MAIN OUTCOME MEASURES: Characteristics and outcomes of patients with carbon dioxide embolus associated with transanal mesorectal excision were measured. RESULTS: Twenty-five cases were reported. The incidence of carbon dioxide embolus during transanal total mesorectal excision is estimated to be ≈0.4% (25/6375 cases). A fall in end tidal carbon dioxide was noted as the initial feature in 22 cases, with 13 (52%) developing signs of hemodynamic compromise. All of the events occurred in the transanal component of dissection, with mean (range) insufflation pressures of 15 mm Hg (12-20 mm Hg). Patients were predominantly (68%) in a Trendelenburg position, between 30° and 45°. Venous bleeding was reported in 20 cases at the time of carbon dioxide embolus, with periprostatic veins documented as the most common site (40%). After carbon dioxide embolus, 84% of cases were completed after hemodynamic stabilization. Two patients required cardiopulmonary resuscitation because of cardiovascular collapse. There were no deaths. LIMITATIONS: This is a retrospective study surveying reported outcomes by surgeons and anesthetists. CONCLUSIONS: Surgeons undertaking transanal total mesorectal excision must be aware of the possibility of carbon dioxide embolus and its potential risk factors, including venous bleeding (wrong plane surgery), high insufflation pressures, and patient positioning. Prompt recognition and management can limit the clinical impact of such events. See Video Abstract at http://links. lww.com/DCR/A961.

AB - BACKGROUND: Carbon dioxide embolus has been reported as a rare but clinically important risk associated with transanal total mesorectal excision surgery. To date, there exists limited data describing the incidence, risk factors, and management of carbon dioxide embolus in transanal total mesorectal excision. OBJECTIVE: This study aimed to obtain data from the transanal total mesorectal excision registries to identify trends and potential risk factors for carbon dioxide embolus specific to this surgical technique. DESIGN: Contributors to both the LOREC and OSTRiCh transanal total mesorectal excision registries were invited to report their incidence of carbon dioxide embolus. Case report forms were collected detailing the patient-specific and technical factors of each event. SETTINGS: The study was conducted at the collaborating centers from the international transanal total mesorectal excision registries. MAIN OUTCOME MEASURES: Characteristics and outcomes of patients with carbon dioxide embolus associated with transanal mesorectal excision were measured. RESULTS: Twenty-five cases were reported. The incidence of carbon dioxide embolus during transanal total mesorectal excision is estimated to be ≈0.4% (25/6375 cases). A fall in end tidal carbon dioxide was noted as the initial feature in 22 cases, with 13 (52%) developing signs of hemodynamic compromise. All of the events occurred in the transanal component of dissection, with mean (range) insufflation pressures of 15 mm Hg (12-20 mm Hg). Patients were predominantly (68%) in a Trendelenburg position, between 30° and 45°. Venous bleeding was reported in 20 cases at the time of carbon dioxide embolus, with periprostatic veins documented as the most common site (40%). After carbon dioxide embolus, 84% of cases were completed after hemodynamic stabilization. Two patients required cardiopulmonary resuscitation because of cardiovascular collapse. There were no deaths. LIMITATIONS: This is a retrospective study surveying reported outcomes by surgeons and anesthetists. CONCLUSIONS: Surgeons undertaking transanal total mesorectal excision must be aware of the possibility of carbon dioxide embolus and its potential risk factors, including venous bleeding (wrong plane surgery), high insufflation pressures, and patient positioning. Prompt recognition and management can limit the clinical impact of such events. See Video Abstract at http://links. lww.com/DCR/A961.

KW - 80 and over

KW - Adult

KW - Aged

KW - Air

KW - Carbon Dioxide

KW - Carbon dioxide embolus

KW - Embolism

KW - Female

KW - Hemorrhage

KW - Humans

KW - Insufflation

KW - Internationality

KW - Intraoperative Complications

KW - Male

KW - Middle Aged

KW - Patient Positioning

KW - Postoperative Care

KW - Rectal surgery

KW - Rectum

KW - Registries

KW - Registry report

KW - Retrospective Studies

KW - Risk Factors

KW - Transanal

KW - Transanal Endoscopic Surgery

KW - Transanal total mesorectal excision

KW - Veins

KW - 80 and over

KW - Adult

KW - Aged

KW - Air

KW - Carbon Dioxide

KW - Carbon dioxide embolus

KW - Embolism

KW - Female

KW - Hemorrhage

KW - Humans

KW - Insufflation

KW - Internationality

KW - Intraoperative Complications

KW - Male

KW - Middle Aged

KW - Patient Positioning

KW - Postoperative Care

KW - Rectal surgery

KW - Rectum

KW - Registries

KW - Registry report

KW - Retrospective Studies

KW - Risk Factors

KW - Transanal

KW - Transanal Endoscopic Surgery

KW - Transanal total mesorectal excision

KW - Veins

UR - https://publicatt.unicatt.it/handle/10807/170593

UR - https://www.scopus.com/inward/citedby.uri?partnerID=HzOxMe3b&scp=85067832271&origin=inward

UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85067832271&origin=inward

U2 - 10.1097/DCR.0000000000001410

DO - 10.1097/DCR.0000000000001410

M3 - Article

SN - 0012-3706

VL - 62

SP - 794

EP - 801

JO - Diseases of the Colon and Rectum

JF - Diseases of the Colon and Rectum

IS - 7

ER -

Carbon dioxide embolism associated with transanal total mesorectal excision surgery: A report from the international registries

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