• Jae Ho Choi, Jae Hwa Yoo, Won Ho Chang, Young Woo Park, Hyun Jo Kim, and Hong Chul Oh.
• Department of Thoracic and Cardiovascular surgery, Soonchunhyang University Hospital Seoul, Seoul, Republic of Korea.
• Medicine (Baltimore). 2024 Apr 5; 103 (14): e37638e37638.

RationaleGuide wire aspiration during central venous catheter (CVC) insertion in a patient on extracorporeal membrane oxygenation (ECMO) is a very rare but dangerous complication. A guide wire aspirated inside the ECMO can cause thrombosis, the ECMO to break down or shut off, and unnecessary ECMO replacement.Patient ConcernsA 58-year-old man was scheduled for venovenous ECMO for acute respiratory distress syndrome. After his vital signs stabilized, we inserted a CVC. During CVC insertion, the guide wire was aspirated into the ECMO venous line.InterventionAfter confirming the guide wire inside the ECMO venous line, we replaced the entire ECMO circuit.OutcomesECMO was maintained for 57 days, and weaning was successful but the patient died 5 days afterward.LessonsCare must be taken when inserting a CVC using a guide wire in ECMO patients: the guide wire should not be inserted deeply, it should be secured during insertion, the ECMO venous cannula tip requires proper positioning, and ECMO flow should be temporarily reduced.Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.

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