Image in Intensive Medicine
Mobile thrombus in right atrium during cannulation of veno-venous extracorporeal membrane oxygenation
Trombo móvil en la aurícula derecha durante la canulación de una membrana de oxigenación estracorpórea veno-venosa
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He developed severe refractory respiratory failure (PaO2/FiO2<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>100) and hemodynamic instability secondary to hypoxemia. Due to the inability to oxygenate the patient, it was decided to begin with veno-venous ECMO therapy. During cannulation of the femoral vein, a large thrombus (white arrow) was observed in the right atrium passing through the tricuspid valve into the pulmonary artery (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>); suddenly, the patient suffered cardiac arrest in pulseless electrical activity (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>), requiring advanced CPR maneuvers, recovering spontaneous circulation once ECMO therapy begun (Video). He remained under ECMO for seven days, after which, it was withdrawn due to respiratory improvement. 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