Irrigation of a semiclosed wound with hydrogen peroxide was followed by sudden circulatory collapse and asystole intraoperatively, suggestive of venous oxygen embolism, with full recovery after 6 minutes of CPR and return of spontaneous circulation.
Key Findings
Results
Hydrogen peroxide wound irrigation was temporally associated with sudden intraoperative cardiovascular collapse progressing to asystole.
The patient was a man in his 20s undergoing wound debridement and external fixation for a femoral fracture sustained in a blast injury.
Approximately 45 minutes after anesthesia induction, irrigation of a semiclosed wound with hydrogen peroxide was followed by a sudden fall in end-tidal carbon dioxide and tachycardia.
The tachycardia progressed rapidly to asystole.
The authors describe the close temporal link between hydrogen peroxide irrigation and circulatory collapse as 'suggestive of intraoperative oxygen embolism, likely facilitated by oxygen liberation in a confined cavity.'
Results
Cardiopulmonary resuscitation resulted in return of spontaneous circulation within 6 minutes.
CPR was started immediately following asystole.
Tracheal intubation was performed during the first cycle of compressions.
Return of spontaneous circulation occurred 6 minutes after CPR was initiated.
The patient recovered fully with no neurological or cardiovascular sequelae.
Discussion
The mechanism of cardiovascular collapse was attributed to venous oxygen embolism secondary to hydrogen peroxide use in a semiclosed wound cavity.
Hydrogen peroxide liberates oxygen gas upon contact with tissue, which can enter venous circulation.
The wound was described as 'semiclosed,' which the authors suggest facilitated oxygen liberation in a confined cavity.
The diagnosis of oxygen embolism was based on clinical presentation and temporal association rather than confirmatory imaging or laboratory testing.
This mechanism is consistent with previously recognized but rare complications of hydrogen peroxide irrigation.
Results
The case was managed under an airway secured with an i-gel laryngeal mask at the time of collapse, requiring upgrade to tracheal intubation during resuscitation.
Anesthesia was induced with propofol and nalbuphine.
The airway was initially secured with an i-gel laryngeal mask airway.
Tracheal intubation was performed during the first cycle of chest compressions as part of resuscitation.
The use of a supraglottic airway device at the time of the event may be relevant to airway management considerations during resuscitation.
Conclusions
The authors recommend limiting or avoiding hydrogen peroxide as a wound irrigant whenever possible and maintaining preparedness for cardiovascular emergencies when its use is unavoidable.
The case 'highlights the need to limit or avoid the use of hydrogen peroxide as irrigant whenever possible.'
Clinicians are advised to 'exercise caution and preparedness whenever its use becomes unavoidable.'
The risk is considered particularly relevant in semiclosed or confined wound cavities where gas liberation may be trapped and enter venous circulation.
This recommendation is based on a single case report, which limits generalizability but underscores a potentially life-threatening complication.
What This Means
This case report describes a young man who suffered a life-threatening cardiac arrest during surgery after his wound was irrigated with hydrogen peroxide, a common antiseptic. About 45 minutes into the operation for a blast-related leg fracture, shortly after hydrogen peroxide was used to clean the wound, the patient's heart rate spiked and then stopped entirely. The medical team immediately began CPR, inserted a breathing tube, and successfully restarted his heart after 6 minutes. He made a full recovery with no lasting brain or heart damage.
The doctors believe the collapse was caused by oxygen gas entering the bloodstream — a condition called venous gas embolism. Hydrogen peroxide releases oxygen bubbles when it contacts tissue, and in this case the wound was partially closed, which may have trapped the gas and forced it into nearby veins. Once in the bloodstream, large amounts of oxygen gas can block blood flow through the heart and lungs, causing cardiac arrest. The diagnosis was based on the timing of events rather than a specific test, as no imaging was performed to confirm gas in the vessels.
This research suggests that hydrogen peroxide, while widely used for wound cleaning, carries a rare but potentially fatal risk when used in enclosed or deep wound cavities. The authors emphasize that surgeons and anesthesiologists should avoid hydrogen peroxide irrigation when possible and be prepared to respond rapidly to cardiovascular emergencies if it must be used. For patients and caregivers, this case is a reminder that even familiar medical products can have serious risks depending on how and where they are applied.
Sharafat M, Khan Z, Sohaib M, Dogar S. (2026). Suspected venous oxygen embolism following hydrogen peroxide wound irrigation causing intraoperative asystole.. BMJ case reports. https://doi.org/10.1136/bcr-2025-271477