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Fatal air embolism as complication of percutaneous dilatational tracheostomy on venovenous extracorporeal membrane oxygenation, two case reports.

Lother A, Wengenmayer T, Benk C, Bode C, Staudacher DL - J Cardiothorac Surg (2016)

Bottom Line: Therefore, most patients with an indication for venovenous extracorporeal membrane oxygenation (ECMO) will also have an indication for tracheostomy.Both patients had an AVALON ELITE® bi-caval cannula implanted draining blood from the vena cava superior and inferior.Since there is limited safety data on this specific group of patients, a routine early dilatational tracheostomy might be associated with a significant risk.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology and Angiology I, Heart Center Freiburg University, Hugstetterstrasse 55, 79106, Freiburg, Germany.

ABSTRACT

Background: Tracheostomy is recommended in case of prolonged mechanical ventilation. Therefore, most patients with an indication for venovenous extracorporeal membrane oxygenation (ECMO) will also have an indication for tracheostomy.

Case presentation: We report 2 cases of fatal air embolism into the ECMO system as complication of percutaneous dilatational tracheostomy. Both patients had an AVALON ELITE® bi-caval cannula implanted draining blood from the vena cava superior and inferior.

Conclusion: Since there is limited safety data on this specific group of patients, a routine early dilatational tracheostomy might be associated with a significant risk.

No MeSH data available.


Related in: MedlinePlus

Air embolization into the ECMO system during tracheostomy. The AVALON ELITE bi-caval cannula drains venous blood from the superior as well as the inferior vena cava. Since the inferior thyroid vein directly drains into the vena cava superior, a venous damage during tracheostomy might result in severe air embolization into the ECMO
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Fig1: Air embolization into the ECMO system during tracheostomy. The AVALON ELITE bi-caval cannula drains venous blood from the superior as well as the inferior vena cava. Since the inferior thyroid vein directly drains into the vena cava superior, a venous damage during tracheostomy might result in severe air embolization into the ECMO

Mentions: In the 2 patients presented here, the air embolization into the ECMO was detected seconds after dilation with a percutaneous tracheostomy dilator. Both patients were on full ECMO support via an AVALON ELITE® (Maquet, Germany) bi-caval dual lumen cannula draining blood directly from the superior vena cava (Fig. 1). Especially with higher ECMO blood flow, this might result in significant negative pressure in the draining vessels. We therefore hypothesize that suction of air through the inferior thyroidal vein draining blood directly to the vena cava superior might be responsible for fatal air embolism in both patients.Fig. 1


Fatal air embolism as complication of percutaneous dilatational tracheostomy on venovenous extracorporeal membrane oxygenation, two case reports.

Lother A, Wengenmayer T, Benk C, Bode C, Staudacher DL - J Cardiothorac Surg (2016)

Air embolization into the ECMO system during tracheostomy. The AVALON ELITE bi-caval cannula drains venous blood from the superior as well as the inferior vena cava. Since the inferior thyroid vein directly drains into the vena cava superior, a venous damage during tracheostomy might result in severe air embolization into the ECMO
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4940884&req=5

Fig1: Air embolization into the ECMO system during tracheostomy. The AVALON ELITE bi-caval cannula drains venous blood from the superior as well as the inferior vena cava. Since the inferior thyroid vein directly drains into the vena cava superior, a venous damage during tracheostomy might result in severe air embolization into the ECMO
Mentions: In the 2 patients presented here, the air embolization into the ECMO was detected seconds after dilation with a percutaneous tracheostomy dilator. Both patients were on full ECMO support via an AVALON ELITE® (Maquet, Germany) bi-caval dual lumen cannula draining blood directly from the superior vena cava (Fig. 1). Especially with higher ECMO blood flow, this might result in significant negative pressure in the draining vessels. We therefore hypothesize that suction of air through the inferior thyroidal vein draining blood directly to the vena cava superior might be responsible for fatal air embolism in both patients.Fig. 1

Bottom Line: Therefore, most patients with an indication for venovenous extracorporeal membrane oxygenation (ECMO) will also have an indication for tracheostomy.Both patients had an AVALON ELITE® bi-caval cannula implanted draining blood from the vena cava superior and inferior.Since there is limited safety data on this specific group of patients, a routine early dilatational tracheostomy might be associated with a significant risk.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology and Angiology I, Heart Center Freiburg University, Hugstetterstrasse 55, 79106, Freiburg, Germany.

ABSTRACT

Background: Tracheostomy is recommended in case of prolonged mechanical ventilation. Therefore, most patients with an indication for venovenous extracorporeal membrane oxygenation (ECMO) will also have an indication for tracheostomy.

Case presentation: We report 2 cases of fatal air embolism into the ECMO system as complication of percutaneous dilatational tracheostomy. Both patients had an AVALON ELITE® bi-caval cannula implanted draining blood from the vena cava superior and inferior.

Conclusion: Since there is limited safety data on this specific group of patients, a routine early dilatational tracheostomy might be associated with a significant risk.

No MeSH data available.


Related in: MedlinePlus