P042: CARDIAC ARREST DURING AGITATED SALINE INJECTION FOR TEE IN A PATIENT WITH PULMONARY HTN AND PFO
Jamshed Desai, MD; Santiago Luis, MD
Cleveland Clinic Florida
A 50F with pulmonary hypertension, right ventricular failure, and atrial fibrilation who went into cardiac arrest shortly after administration of agitated saline during a TEE. The exam was performed due to multiple acute cerebral infarcts, for which she presented with AMS two days prior. The TEE revealed a mildly dialated right ventricle with moderately reduced systolic function; systolic and diastolic flattening of the interventricular septum; and a patent foramen ovale. Within seconds of agitated saline adminstration, she became hypotensive to 50/30 mmHg and hypoxic, with loss of consciousness. She subsequently suffered a PEA, was given CPR, epinephrine and intubated, with ROSC returning within 3 minutes. Rare case reports of cerebral ischemia after agitated saline administration suggest that the bubbles are capable of acting as microemboli in rare instances. In a patient with tenuous RV function, bubble microemboli to the coronary circulation is a possible explanation for hemodynamic decompensation and subsequent cardiac arrest.