Venoarterial Extracorporeal Membrane Oxygenation Rescue for Catastrophic Grade 3 Bone Cement Implantation Syndrome in a Patient With Aortic Valve Stenosis and Moderate Pulmonary Hypertension: A Case Report

Bone cement implantation syndrome (BCIS) is a rare but potentially fatal complication of cemented arthroplasty, characterized by hypoxia, hypotension, and/or cardiovascular collapse. Although right ventricular failure is considered a key mechanism, its pathophysiology - potentially driven by pulmonary microembolization, complement activation, and the release of histamine - remains poorly defined. Due to the high mortality of severe BCIS, evidence regarding optimal management is limited. An 80-year-old woman with moderate-to-severe aortic valve stenosis and moderate pulmonary hypertension (PH) underwent total hip arthroplasty (THA). Five minutes after bone cement implantation, she developed sudden, profound cardiopulmonary collapse. Pulmonary embolism (PE) was suspected but excluded by transesophageal echocardiography (TEE) and computed tomography (CT) pulmonary angiography. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) was promptly initiated, resulting in hemodynamic stabilization. She was successfully weaned from ECMO and discharged from the Intensive Care Unit (ICU) on Day 23 and from the hospital on Day 52, without neurological complications. This case highlights that prompt recognition of BCIS and immediate VA-ECMO initiation may be vital for achieving favorable outcomes in catastrophic BCIS, in selected cases managed at specialized centers.