Gynaecological Laparoscopy Surgery Complicated Into CO2 Embolism, Cardiac Arrest and Severe ARDS Requiring ECMO Therapy.

Laparoscopic surgeries have revolutionised surgical practice due to their advantages, including minimal invasiveness, fewer postoperative complications, quicker recovery and reduced hospital stay. Carbon dioxide (CO2) is used for abdominal insufflation because of its inert nature, colorlessness, low cost, high solubility, low combustibility and wide availability. Despite these advantages, laparoscopy is not without complications-it can cause hypotension, arrhythmia, pulmonary barotrauma and, rarely, carbon dioxide embolism (CO2E) and cardiac arrest. CO2E is commonly associated with cardiac arrest and has rarely been linked to acute respiratory distress syndrome (ARDS). Cases of CO2E complicated by ARDS have shown improvement with conventional invasive lung-protective ventilation. However, CO2E complicated by severe ARDS with hypoxia refractory to standard therapy has not been reported. We report a case of CO2E complicated by severe ARDS with refractory hypoxia requiring extracorporeal membrane oxygenation (ECMO) therapy, which resulted in a favourable outcome.