Risk management for cardiorespiratory complication during ERCP treatment

Abstract

We sometimes experience an acute cardiorespiratory complication such as hypotension, bradycardia, hypoxia or cardiac arrest during ERCP treatment under deep sedation. The incidence is known to be high especially in patients with comorbid diseases. We first evaluated the relationship during American Society of Anesthesiologists physical status (ASA-PS) and cardiorespiratory complication in our institution. The ASA-PS classification was significantly higher in the patients with a cardiorespiratory vital change requiring intervention during ERCP compared to the control. Therefore, it is necessary to check the underlying disease of the patient at timeout, and to decide the dose of sedative agent according to patient’s condition. Secondary, we evaluated an introduction of a simulation-based crisis resource management training (SBT) for endoscopic unit, under cooperation of many medical professions. We successfully construct a safer ERCP examination based on the experience of SBT, by discussing multiple effective safety managements. However, standardization and evaluation of SBT has not been still sufficient, and further study is required. The carefully planned SBT was useful for promoting safe and reliable endoscopic examination, and is expected to be introduced in many facilities in the future.