A 31-year-old woman at 41 weeks gestation presented after a home-delivery attempt, resulting in an intrauterine fetal demise. A cesarean section revealed purulent amniotic fluid. The patient had a hypoxic cardiopulmonary arrest due to aspiration and fluid overload from resuscitation. Veno-venous extracorporeal membrane oxygenation (V-V ECMO) via femorofemoral approach was initiated to treat refractory hypoxemia. Because of the emergent nature, a cardiac ultrasound probe was not readily available to verify guidewire placement. However, there was no resistance during placement; adequate flows were obtained. She was transferred to our tertiary ECMO center.

A computed tomographic angiography to investigate her cardiac arrest revealed the 25-Fr drainage cannula exiting the inferior vena cava (IVC) into a lumbar vein (Figures 1–3). Because the proximal drainage port was low-lying, the cannula was retracted by 3 cm. The ECMO run was uneventful, without chattering, low flows, or low-pressure alarms. The patient was discharged home without neurological deficits.