Macroscopic Pulmonary Fat Embolism Secondary to Intraosseous Line Placement: A Case Report

Background: Intraosseous access is commonly used for vascular access in emergent settings. It is generally thought to be well-tolerated with minimal complications. We report the first case of clinically significant macroscopic pulmonary fat embolism secondary to intraosseous access. Case presentation: A 67-year-old woman developed profound hypotension and severe biventricular dysfunction shortly after intraosseous access and resuscitation. She required emergent veno-arterial extracorporeal membrane oxygenation and Impella for cardiopulmonary support. Computed tomography noted new macroscopic pulmonary fat embolism compared to prior imaging one day prior. Aspiration thrombectomy was successfully performed with significant improvement in hemodynamics. Unfortunately, she suffered anoxic brain injury during resuscitation and was ultimately transitioned to comfort care. Conclusions: Although intraosseous access is often considered a safe procedure, this case highlights the need for awareness of this rare but serious, and potentially lethal complication. Treatment of pulmonary fat embolism is often supportive, however aspiration thrombectomy has a potential therapeutic role in macroscopic cases.