Published online Sep 6, 2018. doi: 10.12998/wjcc.v6.i9.274
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
A 47-year-old male with extracorporeal membrane oxygenation (ECMO) support developed sudden cardiogenic shock and loss of consciousness.
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 includes acute myocardial infarction, cerebral thromboembolism, and cerebral hemorrhage.
Brain CT showed massive cerebral air embolism.
The patient was placed in the Trendelenburg position.
Bronchovenous fistula (BVF) can cause systemic air embolism when the alveolar pressure exceeds pulmonary venous pressure.
BVF is a connection between alveolar and pulmonary vein caused by pulmonary injury.
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.