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
Case characteristics

A 47-year-old male with extracorporeal membrane oxygenation (ECMO) support developed sudden cardiogenic shock and loss of consciousness.

Clinical diagnosis

The electrocardiography finding suggested acute inferior and anteroseptal wall ischemia, and the loss of consciousness was thought to be the consequence of the cardiogenic shock because the ECMO flow was low.

Differential diagnosis

Differential diagnosis includes acute myocardial infarction, cerebral thromboembolism, and cerebral hemorrhage.

Imaging diagnosis

Brain CT showed massive cerebral air embolism.


The patient was placed in the Trendelenburg position.

Related reports

Bronchovenous fistula (BVF) can cause systemic air embolism when the alveolar pressure exceeds pulmonary venous pressure.

Term explanation

BVF is a connection between alveolar and pulmonary vein caused by pulmonary injury.

Experiences and lessons

ECMO support can increase the risk of systemic air embolism caused by BVF fistula, and this complication should be suspected when there is sudden bradycardia with loss of consciousness.