Intraoperative Fat Embolism Syndrome Causing Acute Right Ventricular Failure Successfully Treated With Veno-Arterial Extracorporeal Membrane Oxygenation: A Case Report

Fat embolism syndrome (FES) is a rare but potentially fatal complication of orthopedic surgery. Although extracorporeal support has been reported in trauma-related FES, the use of veno-arterial extracorporeal membrane oxygenation (V-A ECMO) for FES during elective arthroplasty has not been described. We report a case of a 67-year-old woman undergoing revision total hip arthroplasty. During the procedure, she developed profound hypoxemia and refractory hypotension following an iatrogenic femoral fracture prior to cement fixation. Despite fluid resuscitation and vasopressor and inotropic therapy, cardiovascular collapse progressed. The clinical course was consistent with FES complicated by acute right ventricular failure and pulmonary hypertension, and V-A ECMO was initiated for circulatory support. The patient was successfully liberated from ECMO on postoperative day 4 and discharged home without major complications. This case illustrates that fulminant intraoperative FES can cause abrupt right ventricular failure even during elective arthroplasty and suggests that early recognition and timely initiation of V-A ECMO may be lifesaving.