title: Fatal air embolism as complication of percutaneous dilatational tracheostomy on venovenous extracorporeal membrane oxygenation, two case reports.
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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  Since there is limited safety data on this specific group of patients, a routine early dilatational tracheostomy might be associated with a significant risk.
authors.affiliation: Department of Cardiology and Angiology I, Heart Center Freiburg University, Hugstetterstrasse 55, 79106, Freiburg, Germany.
authors.forename: Achim
authors.initials: A
authors.lastname: Lother
authors.affiliation: Department of Cardiology and Angiology I, Heart Center Freiburg University, Hugstetterstrasse 55, 79106, Freiburg, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Wengenmayer
authors.affiliation: Department of Cardiovascular Surgery, Heart Center Freiburg University, Freiburg, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Benk
authors.affiliation: Department of Cardiology and Angiology I, Heart Center Freiburg University, Hugstetterstrasse 55, 79106, Freiburg, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Bode
authors.affiliation: Department of Cardiology and Angiology I, Heart Center Freiburg University, Hugstetterstrasse 55, 79106, Freiburg, Germany. dawid.staudacher@universitaets-herzzentrum.de.
authors.forename: Dawid L
authors.initials: DL
authors.lastname: Staudacher
mesh_terms: D000368:Aged; D004106:Dilatation; D004618:Embolism, Air / Q000209:etiology*; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012121:Respiration, Artificial / Q000009:adverse effects*; D012131:Respiratory Insufficiency / Q000601:surgery*; D014132:Trachea / Q000601:surgery*; D014139:Tracheostomy / Q000009:adverse effects* / Q000379:methods
keywords: Air embolization; Case report; Complication; ECMO; Extracorporeal membrane oxygenation; Percutaneous dilatational tracheostomy