Intravascular guide wire aspiration in a patient on extracorporeal membrane oxygenation: A case report

Abstract

Rationale: Guide wire aspiration during central venous catheter (CVC) insertion in a patient on extracorporeal membrane oxygenation (ECMO) is a very rare but dangerous complication. A guide wire aspirated inside the ECMO can cause thrombosis, the ECMO to break down or shut off, and unnecessary ECMO replacement. Patient concerns: A 58-year-old man was scheduled for venovenous ECMO for acute respiratory distress syndrome. After his vital signs stabilized, we inserted a CVC. During CVC insertion, the guide wire was aspirated into the ECMO venous line. Intervention: After confirming the guide wire inside the ECMO venous line, we replaced the entire ECMO circuit. Outcomes: ECMO was maintained for 57 days, and weaning was successful but the patient died 5 days afterward. Lessons: Care must be taken when inserting a CVC using a guide wire in ECMO patients: the guide wire should not be inserted deeply, it should be secured during insertion, the ECMO venous cannula tip requires proper positioning, and ECMO flow should be temporarily reduced.