Sudden Apnea Following Attempted Central Line Placement

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CHEST I 100 I 2 I AUGUST. 1991 505 (Chest 1991; 100:505-06) A 75-year-old man presented with the acute onset of lumbosacral pain that radiated circumferentially to his abdomen. There was no history of trauma, fevers, chills, or renal calculi. His medical history was significant for an abdominal aortic aneurysm measuring 4 X 6 cm since 1986, a right upper lobectomy in 1980 for localized squamous cell carcinoma, and chronic obstructive pulmonary disease. Blood pressures were equal in each arm. The abdomen was soft, difftmsely tender, with a 10-cm pulsatile mass to the left of midline. There was no rebound tenderness or abnormal bowel so)und. Stool was hemoccult negative. Distal pulses were decreased symmetrically. Findings from the remainder of the physical examination were tmnremarkable. Results oflaboratory studies were all within normal limits. A chest roentgenogram revealed right upper lobe scarring and surgical clips, consistent with a previous upper lobectomy, as well as changes consistent with chronic obstructive pulmonary disease. A lumbosacral spine series revealed normal bone structures and a 10-cm abdominal aortic aneurysm outlined by luminal calcifications. In preparation for an abdominal computed tonnographic (CT) scan, followed by surgical repair, attempts were made to eStal)lish central venous access via the right internal jugular approach. After placing the patient in the Trendelenburg position, the vein was easily cannulated; however, resistance was met while trying to advance the guidewire. The patient l)ecamne apneic amid developed electro)mnechanical (lisso)ciatio)ml followed i y asystole. He was imitul)ated, and cardio)pulmno)nary rescusitation vas l)egun. An 18-gauge needle was placed imito the seco)nd intercostal space in the event these cardiac disturbances were secondary to a tension 1)Iietln )tho)rax, and an emergency chest ro)entgenogram was obtained (Fig 1).