Abstract
A 66-year-old female with an unremarkable medical history and presenting with a 2-year history of dysphagia, regurgitation, and weight loss was diagnosed with achalasia. Peroral endoscopic myotomy (POEM) was decided upon.
Results of the standard pre-anaesthesia evaluation proved unremarkable. Low-flow carbon dioxide was used throughout the procedure.
Anterior mucosotomy was performed and a submucosal tunnel created. Percutaneous abdominal needle decompression resulted in normalisation of maximum airway pressure.
After the first 3 cm of myotomy had been performed, endoscopically visible movement of the pericardium suddenly stopped ([Video 1]). The knife had not come in contact with, or within the close vicinity of, the pericardium.
Although electrocardiographic monitoring showed continuous but slow electrical activity, the central and peripheral pulses were not present. Cardiopulmonary resuscitation was immediately initiated.
Bedside examination ruled out the presence of pneumothorax, tamponade, or pulmonary embolism. Despite advanced cardiac life support, the resuscitation was unsuccessful.