Use of venovenous extra-corporal membrane oxygenation in acute respiratory distress syndrome secondary to surgical air embolism: A favorable outcome case report.

Background: Although air embolism is a rare intraoperative complication associated with sitting or semi-sitting positioning during neurosurgical procedures, it carries a high morbidity and mortality rate. Prompt recognition is paramount; however, the treatment options are limited. We present the first case of intraoperative venous air embolism (VAE) that was successfully treated with venovenous extra-corporal membrane oxygenation (VVECMO) in a patient undergoing retro-sigmoid craniotomy for a vestibular schwannoma resection in the sitting position. Case Description: We present a young male who developed VAE requiring VV-ECMO after undergoing vestibular schwannoma resection through right retro-sigmoid craniotomy in sitting position. Diagnosis was made intraoperatively with the aspiration of air through the subclavian central venous catheter. Patient developed both indirect and direct pathophysiological changes of air embolism. Successful VV-ECMO resulted in resolution of indirect effects and good prognosis of the patient. Conclusion: Acuteness of judgment, understanding, and prompt response is required to diagnose and successfully treat pulmonary air embolism. In this report, we will discuss the occurrence, diagnosis, pathophysiology, and treatment of acute pulmonary air embolism in an operative setting. To date successful treatment of air embolism through venovenous extracorporeal membranous oxygenation, secondary to neurosurgical procedure has not been reported.