Luis CoentraoRoberto Roncon-Albuquerque JrPedro ReisTeresa OliveiraJose Artur Paiva

Cardiac arrest after left subclavian venouscatheter insertion

Received: 12 June 2014Accepted: 13 June 2014Published online: 26 June 2014� Springer-Verlag Berlin Heidelberg and ESICM 2014

L. Coentrao ()) � R. Roncon-Albuquerque Jr �T. Oliveira � J. A. PaivaIntensive Care Medicine Department, Hospital S. Joao,Alameda Prof. Hernani Monteiro, 4200 Porto, Portugale-mail: coentrao@med.up.ptTel.: ?351 961313495

P. ReisAnesthesiology Department, Hospital S. Joao,Alameda Prof Hernani Monteiro, 4200 Porto, Portugal

A 39-year-old obese woman presented with influenza A(H1N1)-related acute respiratory distress syndrome(ARDS). At day 2, refractory hypoxemia ensued and veno-venous extracorporeal membrane oxygenation (ECMO) wasinitiated. At day 15, venous catheter-related infection wassuspected and a left subclavian venous catheter was insertedusing the Seldinger technique, with blood that was freelyaspirated before and after insertion of the catheter. However,acute circulatory shock was observed shortly afterwards.The transthoracic echocardiogram revealed pericardialeffusion with collapsed right chambers, suggesting cardiactamponade. The chest X-ray (Fig. 1) showed a malposi-tioned catheter in the left lung. Cardiac arrest ensued and

emergent sternotomy was performed under ECMO-assistedcardiopulmonary resuscitation after femoral artery cannu-lation (venous-venous-arterial ECMO). Pulmonary arteryperforation (Fig. 2) and hemopericardium were then surgi-cally repaired after catheter withdrawal. Her hospital coursewas further complicated by severe ARDS secondary toEnterococcus faecalis bacteremia with redo veno-venousECMO. The patient made a full recovery and was dischargedhome 2.5 months after hospital admission with no neuro-logic or cardiopulmonary sequelae.

Fig. 1 Chest X-ray showing the malpositioned left subclaviancentral venous catheter

Intensive Care Med (2014) 40:1367–1368DOI 10.1007/s00134-014-3377-6 IMAGING IN INTENSIVE CARE MEDICINE

Consent and permission to publish this case report andthe accompanying images was obtained from the patientand his family.

Conflicts of interest On behalf of all authors, the correspondingauthor states that there is no conflict of interest.

Fig. 2 Pulmonary artery perforation by the left subclavian centralvenous catheter

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