Leading Perfusionist Discusses Air Embolism From Extracorporeal Membrane Oxygenation System Failure

Perfusionist Expert WitnessThis case involves a juvenile female patient in Idaho who underwent a number of surgeries to repair a congenital heart defect that was diagnosed shortly after birth. After the child was born, she underwent a number of surgeries to repair the defect. During one of these surgeries, the ECMO machine that was being used to oxygenate the patient’s blood malfunctioned, causing the perfusionist to manually crank the machine to re-initiate the flow of blood. As this occurred the machine allowed air into the system that subsequently enter the patient. As a result, the child suffered an air embolism and died shortly after the surgery was completed.

Question(s) For Expert Witness

  • 1. Do you have experience in using the ECMO machine? If so, how often do you use it?
  • 2. What are the common complications that can arise from using this machine?
  • 3. How does one mitigate the risk of air embolism?

Expert Witness Response E-006941

Expert-ID: E-006941

Expert Witness Response E-007758

Expert-ID: E-007758

ECMO is a complex therapy that has well documented medical and mechanical complications & emergencies associated with its use in pediatric and adult patients. Mechanical complications include circuit disruption, clots, raceway rupture, inadvertent decannulation, component failure (pump, oxygenator, heaters, etc.) and air embolism. Air can enter an ecmo circuit in a variety of ways. Therefore, ecmo circuits would usually have an air bubble detector on the arterial line which would alarm and stop the pump if air was detected. Additionally, the components of the ecmo circuit can act as bubble traps to sequester air and prevent it from advancing to the patient. Perfusionists and ecmo technicians should be trained and familiar with techniques to safely remove air from the ecmo circuit in emergencies. I would fall back on the basic perfusion principle of “Don’t pump air”. Perfusionists are highly trained to understand, prevent, and avoid the catastrophic consequence of air embolism. So, in lieu more information, I am surprised that a perfusionist would mistakenly hand crank air into this patient.


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