A critically unwell patient was transferred from ICU to theatre for emergency laparotomy. They had already been intubated and an arterial line sited. Due to urgency of the procedure, the anaesthetic team, including a consultant, made the decision to allow the operation to start with 22G and 18G cannulae for access and site a central line during the procedure. On opening the abdomen, the patient had a cardiac arrest. CPR commenced. 2x ICU consultants attended. EZ-IO sited to aid access but all drugs given via peripheral cannula. Chest compressions made it difficult to site a central line but the left internal jugular was eventually cannulated. The results from bloods sent including venous blood gas, were incompatible with life. CPR stopped after 25 minutes after discussion with multidisciplinary team.

Commentary

Even in the most time-critical situation it is essential that adequate intravenous access is obtained prior to surgery. This basic requirement for safe anaesthesia can temporarily be forgotten when the sense of urgency is overwhelming. The use of a safety checklist can help mitigate such a situation. In this case it is unlikely that lack of appropriate IV access was responsible for the outcome.