Zhu GW, Li YM, Yue WH, Sun JX, Zhou X, Xu YX, Wang HB, Zhang QH. Veno-arterial extracorporeal membrane oxygenation for the treatment of obstructive shock caused by venous air embolism: A case report. World J Clin Cases 2024; 12(19): 4016-4021 [PMID: 38994297 DOI: 10.12998/wjcc.v12.i19.4016]
Corresponding Author of This Article
Qing-Hai Zhang, PhD, Doctor, Department of Critical Care Medicine, The First Affiliated Hospital of Shandong Second Medical University, No. 151 Guangwen Street, Kuiwen District, Weifang 261042, Shandong Province, China. zzyxzqh@outlook.com
Research Domain of This Article
Critical Care Medicine
Article-Type of This Article
Case Report
Open-Access Policy of This Article
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: http://creativecommons.org/licenses/by-nc/4.0/
Gui-Wei Zhu, Jian-Xia Sun, Hai-Bo Wang, Qing-Hai Zhang, Department of Critical Care Medicine, The First Affiliated Hospital of Shandong Second Medical University, Weifang 261000, Shandong Province, China
Yan-Min Li, Xin Zhou, Ying-Xia Xu, Office of Medical Affairs, The First Affiliated Hospital of Shandong Second Medical University, Weifang 261042, Shandong Province, China
Wen-Hui Yue, Department of Hand & Foot Orthopedic Surgery, The First Affiliated Hospital of Shandong Second Medical University, Weifang 261000, Shandong Province, China
Author contributions: Zhu GW, Li YM and Yue WH contributed to manuscript writing and editing, and data collection; Sun JX, Zhou X, Xu YX and Wang HB contributed to conceptualization and supervision; Zhang QH performed critical revision of the manuscript for all intellectual contents; All authors have read and approved the final manuscript.
Supported byConstruction and Application of Management Program for Prevention and Treatment of Inpatients with Venous Thromboembolism, No. WFWSJK-2022-111; and Shandong Provincial Medical and Health Science and Technology Development Program, No. 202103050856.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Qing-Hai Zhang, PhD, Doctor, Department of Critical Care Medicine, The First Affiliated Hospital of Shandong Second Medical University, No. 151 Guangwen Street, Kuiwen District, Weifang 261042, Shandong Province, China. zzyxzqh@outlook.com
Received: March 11, 2024 Revised: April 24, 2024 Accepted: May 9, 2024 Published online: July 6, 2024 Processing time: 110 Days and 7.9 Hours
Abstract
BACKGROUND
Venous air embolism (VAE) is a potentially lethal condition, with a reported incidence rate of about 0.13%, and the true incidence may be higher since many VAE are asymptomatic. The current treatments for VAE include Durant's maneuver, aspiration and removal of air through venous catheters, and hyperbaric oxygen therapy. For critically ill patients, use of cardiotonic drugs and chest compressions remain useful strategies. The wider availability of extracorporeal membrane oxygenation (ECMO) has brought a new option for VAE patients.
CASE SUMMARY
A 53-year-old female patient with VAE presented to the emergency clinic due to abdominal pain with fever for 1 d and unconsciousness for 2 h. One day ago, the patient suffered from abdominal pain, fever, and diarrhea. She suddenly became unconscious after going to the toilet during the intravenous infusion of ciprofloxacin 2 h ago, accompanied by nausea and vomiting, during which a small amount of gastric contents were discharged. She was immediately sent to a local hospital, where cranial and chest computed tomography showed bilateral pneumonia as well as accumulated air visible in the right ventricle and pulmonary artery. The condition deteriorated despite endotracheal intubation, rehydration, and other treatments, and the patient was then transferred to our hospital. Veno-arterial ECMO was applied in our hospital, and the patient's condition gradually improved. The patient was successfully weaned from ECMO and extubated after two days.
CONCLUSION
ECMO may be an important treatment for patients with VAE in critical condition.
Core Tip: This report demonstrates that in cases of obstructive shock due to venous air embolism, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) can be a lifesaving intervention. It rapidly restores hemodynamic stability, providing critical support to the patient's circulatory system. The prompt recognition of the condition, the decision to utilize VA-ECMO are all crucial in ensuring a favorable outcome. In summary, this case report underscores the value of VA-ECMO as a therapeutic option in the management of obstructive shock due to venous air embolism, providing a valuable addition to the clinical knowledge and treatment strategies for this rare but potentially fatal condition.
