Extracorporeal membrane oxygenation (ECMO) is an incredible, life-sustaining intervention for patients suffering from a variety of cardiopulmonary insults. However, its use comes with a unique set of risks and potentially devastating complications, including air entrainment and embolism. We present a case of recurrent air entrainment in a patient on veno-venous ECMO after her peripherally inserted central catheter became entrapped within the lumen of her bi-caval, dual lumen ECMO cannula. We briefly discuss considerations for air embolism on ECMO and recommend general strategies to avoid this potentially catastrophic complication.
MarascoSFLukasGMcDonaldM, et al. Review of ECMO (Extra Corporeal Membrane Oxygenation) support in critically ill adult patients. Heart Lung Circ2008; 17(4): S41–S47.
2.
McCarthyCJBehraveshSNaiduSG, et al. Air embolism: practical tips for prevention and treatment. J Clin Med2016; 5(11): 93.
3.
KumarAKeshavamurthySAbrahamJG, et al. Massive air embolism caused by a central venous catheter during extracorporeal membrane oxygenation. J Extra Corpor Technol2019; 51(1): 9–11.
4.
VeselyTM.Air embolism during insertion of central venous catheters. J Vasc Interv Radiol2001; 12(11): 1291–1295.
5.
RyuSMParkSM.Unexpected complication during extracorporeal membrane oxygenation support: ventilator associated systemic air embolism. World J Clin Cases2018; 6(9): 274.
AllenSHolenaDMcCunnM, et al. A review of the fundamental principles and evidence base in the use of extracorporeal membrane oxygenation (ECMO) in critically ill adult patients. J Intensive Care Med2011; 26(1): 13–26.
9.
BromanLMPrahl WittbergLWestlundCJ, et al. Pressure and flow properties of cannulae for extracorporeal membrane oxygenation II: drainage (venous) cannulae. Perfusion2019; 34(1_suppl): 65–73.
10.
ZanattaPFortiABoscoE, et al. Microembolic signals and strategy to prevent gas embolism during extracorporeal membrane oxygenation. J Cardiothorac Surg2010; 5(1): 5.
11.
TimsitJFRuppMBouzaE, et al. A state of the art review on optimal practices to prevent, recognize, and manage complications associated with intravascular devices in the critically ill. Intensive Care Med2018; 44(6): 742–759.
12.
BermanDJSchiaviAFrankSM, et al. Factors that influence flow through intravascular catheters: the clinical relevance of Poiseuille’s law. Transfusion2020; 60(7): 1410–1417.
13.
KuoCTYangYTsengSH, et al. Treat venous air embolism induced acute hypoxemic respiratory failure during retinal surgery by ECMO (VV mode). Acta Cardiol Sin2021; 37(2): 208.
14.
GuoJLWangHBWangH, et al. Transesophageal echocardiography detection of air embolism during endoscopic surgery and validity of hyperbaric oxygen therapy: case report. Medicine2021; 100(23): e26304.
15.
YoshimuraMNakanishiTSakamotoS, et al. Confirmation of optimal guidewire length for central venous catheter placement using transesophageal echocardiography. J Clin Anesth2016; 35: 58–61.
16.
MackVNißlerDKasikciD, et al. Magnetic tracking and electrocardiography-guided tip confirmation system versus fluoroscopy for placement of peripherally inserted central catheters: a randomized, noninferiority comparison. Cardiovasc Intervent Radiol2020; 43(12): 1891–1897.
17.
SantacruzEMateo-LoboRVega-PiñeroB, et al. Intracavitary electrocardiogram (IC-ECG) guidance for peripherally inserted central catheter (PICC) placement. Nutr Hosp2018; 35(5): 1005–1008.
