“Decompression illness” on extracorporeal membrane oxygenation

TL;DR

A rare complication resembling decompression sickness occurred in a patient on ECMO, leading to fatal outcomes, highlighting the need for improved training and prevention strategies.

Contribution

The paper introduces a novel analogy between air embolism in ECMO and decompression sickness, offering insights for prevention.

Findings

Air entered the ECMO circuit due to drainage insufficiency, leading to a fatal outcome.

The complication resembled decompression sickness, emphasizing the need for ECMO team education.

Prompt re-establishment of ECMO flow failed to prevent patient death within 6 hours.

Abstract

Extracorporeal membrane oxygenation (ECMO) is increasingly being used for critically ill patients with cardiopulmonary failure. Air in the ECMO circuit is an emergency, a rare but fatal complication.

We introduce a case of a 76-year-old female who suffered from cardiac arrest complicated with severe trauma and was administered veno-arterial extracorporeal membrane oxygenation. In managing the patient with ECMO, air entered the ECMO circuit, which had not come out nor was folded or broken. Although the ECMO flow was quickly re-established, the patient died 6 h after initiating ECMO therapy.

In this case report, the reason for the complication is drainage insufficiency. This phenomenon is similar to decompression sickness. Understanding this complication is very helpful for educating the ECMO team for preventing this rare but devastating complication of fatal decompression sickness in patients on ECMO.

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