Abstract Rationale Air embolism is a rare but potentially fatal complication during extracorporeal membrane oxygenation (ECMO) support, with reported adult incidence of 0.4-4.6% and mortality near 20%. In lung transplantation, risk increases due to negative drainage pressure and proximity of central venous lines (1-3). Early detection and rapid intervention are crucial to prevent catastrophic outcomes. Case Presentation A 27-year-old man with cystic fibrosis, exocrine pancreatic insufficiency, and secondary diabetes underwent bilateral lung transplantation under central veno-arterial ECMO (total duration: 6 h 55 min). Monitoring included Swan-Ganz catheter and transesophageal echocardiography. Cannulation was uneventful until intraoperative displacement of the right atrial venous cannula raised suspicion of air entry into the circuit. ECMO flow was immediately clamped and stopped; air was evacuated, the circuit reprimed, and support reinitiated without further events.Preventive measures were implemented—Trendelenburg positioning, intracardiac aspiration, and transcranial Doppler surveillance—to minimize embolic risk. The patient remained stable, without echocardiographic or clinical evidence of embolism. Decannulation and reperfusion were successful, and the patient was extubated on postoperative day two and discharged home on April 21, 2025. Discussion Small air volumes can trigger circuit collapse, emphasizing early recognition and protocolized management (1,2). The favorable outcome in this case reflected prompt detection and coordinated team response. Trendelenburg positioning decreases cerebral embolization by promoting air retention in the right atrium. Intracardiac aspiration and circuit de-airing restore ECMO safety, while continuous neurological monitoring ensures early identification of cerebral events. Conclusion Timely recognition and immediate corrective actions are key to preventing severe complications. This case underscores the value of vigilance, communication, and adherence to safety protocols in ECMO-assisted lung transplantation. REFERENCES 1. Kumar A, Keshavamurthy S, Gomez Abraham J, Toyoda Y. Massive air embolism caused by a central venous catheter during extracorporeal membrane oxygenation. J Extra Corpor Technol. 2019;51:9-11. 2. McCarthy CJ, Behravesh S, Naidu SG, Oklu R. Air embolism: Practical tips for prevention and treatment. J Clin Med. 2016;5(11):93. 3. Franco D, Krasna N, Novak R, Esposito G, Izzo R, Belohlavek J, et al. Prevention of air embolism in extracorporeal membrane oxygenation systems: An in vitro study on protection of central venous catheter lumen. Medicina. 2024;60(11):1883. This abstract is funded by: None
Coronell et al. (Fri,) studied this question.