Abstract

Massive Systemic Air Embolism during Extracorporeal Membrane Oxygenation Support of a Neonate with Acute Respiratory Distress Syndrome after Cardiac Surgery

^* Department of Cardiovascular Services, Division of Cardiovascular Surgery, University of Alabama at Birmingham, Birmingham, Alabama
^† Department of Surgery, Division of Cardiovascular Surgery, University of Alabama at Birmingham, Birmingham, Alabama
^‡ Department of Pediatrics, Division of Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama

Address correspondence to: Jeffrey A. Alten, Attending Physician, Department of Pediatrics, Division of Critical Care Medicine, University of Alabama at Birmingham, 1600 Seventh Avenue South, ACC 504, Birmingham, AL 35233. E-mail: jalten@peds.uab.edu

Received: 29 March 2011
Accepted: 2 May 2011

Abstract

Extracorporeal membrane oxygenation (ECMO) is universally accepted as a potential lifesaving therapy for neonates suffering severe cardiorespiratory failure, with survival reported as 81% weaning off ECMO and 69% to hospital discharge in this population. Although ECMO may reduce mortality in certain neonatal patients, it is associated with significant complications. Air in the circuit complicates 4.9% of neonatal ECMO runs, and it is crucial that all ECMO caregivers are trained in the prevention of air embolism and possess the knowledge necessary to efficiently identify and remove air from the ECMO circuit to prevent life threatening consequences. We present a fatal case of neonatal systemic air embolism leading to massive entrainment of air into the ECMO venous return cannula of a neonatal patient with acute respiratory distress syndrome following repair of obstructed total anomalous pulmonary venous connection. We describe the pathophysiology and presentation of this rare condition and the importance of early recognition, due to its high mortality rate.