Case Report
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 6, 2018; 6(9): 274-278
Published online Sep 6, 2018. doi: 10.12998/wjcc.v6.i9.274
Unexpected complication during extracorporeal membrane oxygenation support: Ventilator associated systemic air embolism
Se-Min Ryu, Sung-Min Park
Se-Min Ryu, Sung-Min Park, Department of Thoracic and Cardiovascular Surgery, Kangwon National University Hospital, School of Medicine, Kangwon National Univerity, Chuncheon 24289, South Korea
Author contributions: Ryu SM wrote the report; Park SM designed the report, analyzed the data, and performed the literature search.
Supported by 2014 Research Grant from Kangwon National University.
Informed consent statement: This case report was exempt from the Institutional Review Board standards at Kangwon National University Hospital.
Conflict-of-interest statement: All authors reported no conflict-of-interest to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial(CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Sung-Min Park, MD, PhD, Doctor, Full Professor, Department of Thoracic and Cardiovascular Surgery, Kangwon National University Hospital, School of Medicine, Kangwon National Univerity, 200-722, Baengnyeong-ro 156, Chuncheon 24289, South Korea.
Telephone: +82-33-2582294 Fax: +82-33-2582182
Received: April 2, 2018
Peer-review started: April 2, 2018
First decision: May 8, 2018
Revised: May 31, 2018
Accepted: June 7, 2018
Article in press: June 8, 2018
Published online: September 6, 2018

Systemic air embolism through a bronchovenous fistula (BVF) has been described in patients undergoing positive-pressure ventilation. However, no report has mentioned the potential risks of systemic air embolism through a BVF in patients undergoing extracorporeal membrane oxygenation (ECMO). Positive-pressure ventilation and ECMO support in patients with lung injury can increase the risk of systemic air embolism through a BVF. Increased alveolar pressure, decreased pulmonary venous pressure, and anticoagulation are thought to be the factors that contribute to this complication. Here, we present a case of systemic air embolism in a patient with ECMO and mechanical ventilator support.

Keywords: Air embolism, Extracorporeal membrane oxygenation, Cerebral embolism, Positive-pressure ventilation, Cardio-pulmonary resuscitation

Core tip: Sudden deterioration of patients during extracorporeal membrane oxygenation support is not unusual. Usually, it is thought to result from the critical illness of the patients. This report suggests that some such cases may be related to bronchovenous fistula, which causes cerebral and coronary air embolisms.