Extracorporeal membrane oxygenation therapy for pulmonary decompression illness

A 36-year-old man presented with tetraplegia and hyperventilation after diving. On arrival, he was in shock and an echocardiogram showed air bubbles in the right ventricle. Pulmonary decompression illness was suspected and hyperbaric oxygen therapy (100% oxygen, 2.8 ATA for 60 minutes) was administered. However, the patient’s respiratory status gradually worsened. He also showed right ventricle load D-shape during cardiac ultrasonography, which was attributed to the presence of air bubbles. Chest radiograph revealed a bilateral butterfly shadow (Figure 1). Because the patient’s oxygen saturation level was almost 60%, we decided to initiate extracorporeal membrane oxygenation (ECMO) therapy [1]. Considering that the patient had a hyperdynamic cardiac function and that bubbles generally diminish within 24 hours, we selected venovenous ECMO therapy rather than venoarterial ECMO therapy. This therapy was surprisingly effective, and the patient’s respiratory failure gradually ameliorated. Venovenous ECMO was discontinued on day 7, when a chest X-ray revealed only a small area of consolidation.