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Image in Critical Care
Thoracic surgery
Transjugular central venous catheter guidewire embolism to venoarterial extracorporeal membrane oxygenation cannula
Nilesh Anand Devanandorcid, Sophie Dohntorcid, Michael Farquharsonorcid
Acute and Critical Care 2023;39(1):199-200.
Published online: December 26, 2023

Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia

Corresponding author: Nilesh Anand Devanand Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia Tel: +61411531341 E-mail:
• Received: September 29, 2023   • Accepted: November 13, 2023

©2024 The Korean Society of Critical Care Medicine

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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A multimorbid 69-year-old gentleman presented with non-ST elevation myocardial infarction associated with bradyarrhythmias. Following pacemaker insertion, he developed an asystolic cardiac arrest requiring prolonged cardiopulmonary resuscitation before venoarterial extracorporeal membrane oxygenation (VA ECMO) support was established.
A right internal jugular central venous catheter (CVC) placed under ultrasound guidance in the intensive care unit was complicated by a lost guidewire during skin dilation. Pertinent VA ECMO settings included: pump speed of 3,600 rotations per minute, blood flow rate of 3.9 L/min, and venous circuit pressure of –71 mm Hg.
Immediate neck ultrasound, chest, abdominal, and pelvic X-ray (Figure 1A-C) failed to reveal the guidewire. It was found hours later in the VA ECMO access cannula tubing (Figure 1D) close to the pump (Figure 1E, Supplementary Video 1), confirming our suspicion of an entrained guidewire within the circuit. Nil changes in venous access cannulae parameters were noted. It was successfully removed later with a circuit change.
Transient ECMO flow reduction with diligent guidewire control during CVC insertion in a VA ECMO patient [1] is vital due to the negative caval pressure. Maintaining continuous wire contact or clamping the guidewire [1,2] to the sterile drape offers a simple solution to prevent catastrophic complications [3,4].


No potential conflict of interest relevant to this article was reported.




Patient consent was waived for this clinical imaging report.

We thank Dr. Amy Sanguesa FCICM (Intensive Care Unit, Royal Adelaide Hospital) and Mr. Jason Quinn (Picture Archiving and Communication Systems Manager, Royal Adelaide Hospital) for procuring the clinical and radiological images, respectively.


Conceptualization: NAD, MF. Data curation: NAD, SD. Project administration: NAD. Writing–original draft: NAD. Writing–review & editing: all authors.

Supplementary materials can be found via

Supplementary Video 1.

Figure 1.
(A) The chest X-ray demonstrates a right internal jugular central venous catheter, along with an automated implantable cardioverter-defibrillator. (B, C) The right femoral venous access cannula is visible along the course of the inferior vena cava to the right femoral vein. The guide wire was not visible in any of these bedside X-ray imaging. (D) On closer inspection, the guidewire (arrow) was barely visible in the venous access cannula. (E) The guidewire (arrow) was subsequently found at the terminal end of the cannula following venous drainage upon preparation for cannula exchange.
  • 1. Picard L, Cherait C, Constant O, Boulanger B, Dorget A, Vodovar D, et al. Central venous catheter placement during extracorporeal membrane oxygenation therapy. Anaesth Crit Care Pain Med 2018;37:269-70.ArticlePubMed
  • 2. Parikh GP, Shonde S, Shah R, Kharadi N. A case of guidewire embolism during central venous catheterization: better safe than sorry! Indian J Crit Care Med 2014;18:831-3.ArticlePubMedPMC
  • 3. Aizawa M, Ishihara S, Yokoyama T. ECMO circuit embolism: a potentially hazardous complication during ECMO therapy. J Clin Anesth 2019;54:162-3.ArticlePubMed
  • 4. Pokharel K, Biswas BK, Tripathi M, Subedi A. Missed central venous guide wires: a systematic analysis of published case reports. Crit Care Med 2015;43:1745-56.PubMed

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        • Citation for the content below
        Transjugular central venous catheter guidewire embolism to venoarterial extracorporeal membrane oxygenation cannula
        Acute Crit Care. 2024;39(1):199-200.   Published online December 26, 2023
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