Carbon Dioxide Embolism

Laparoscopic surgery has gained increasing popularity in clinical practice. As part of laparoscopic surgeries, gas insufflation is usually adopted to increase operative space and visualization for surgeons. The abdomen is the most common location for these laparoscopic interventions, particularly gastrointestinal and gynecologic surgeries. Carbon dioxide (CO₂) is the most commonly used gas for insufflation during laparoscopic surgery because it is colorless, inexpensive, non-flammable, and has higher blood solubility than air, which reduces the risk of complications if venous embolism occurs.

The use of CO₂ gas for insufflation presents some risks. Among the most common complications associated with CO₂ insufflation is CO₂ embolism. Although CO₂ micro embolism commonly occurs during laparoscopy, clinically significant emboli are rare and potentially fatal. The clinical sign of CO2 embolism depends on the volume of embolized gas and range from asymptomatic to cardiovascular collapse or even death. This topic reviews the epidemiology, pathophysiology, clinical presentation, treatment, and prevention of CO₂ embolisms.