BMJ Case Reports 2017; doi:10.1136/bcr-2017-220179
  • Unexpected outcome (positive or negative) including adverse drug reactions

Cardiac arrest following arteriovenous fistula manipulation: a cautionary note

  1. Bimbi S Fernando
  1. Royal Free London NHS Foundation Trust, London, UK
  1. Correspondence to Dr Miles Gandolfi, miles.gandolfi{at}
  • Accepted 23 May 2017
  • Published 13 June 2017


Arteriovenous fistulas can lead to a number of different chronic complications. We describe a case where a patient developed a thrombosis within her brachiobasilic arteriovenous fistula, which was manually manipulated in order to restore fistula flow. This resulted in a pulseless electrical activity cardiac arrest within a few minutes. After ten minutes of chest compressions and intubation, there was return of spontaneous circulation. No epinephrine was given nor shocks administered. Patient was extubated within minutes and was alert, orientated and haemodynamically stable. CT pulmonary angiogram showed extensive bilateral pulmonary emboli. Manual manipulation of the arteriovenous fistula lead to significant amounts of thrombus embolising to the pulmonary arteries, and resultant cardiac arrest due to circulatory compromise. Chest compressions likely dislodged these emboli, allowing circulation to recommence. We publish this as a cautionary note of a rare but potentially fatal complication.


  • Contributors Both MG and BSF were involved in producing this paper by making substantial contributions to the conception or design of the work. Drafting the work and revising it critically for important intellectual content, giving final approval of the version to be published. They are in agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Competing interests None declared.

  • Patient consent Consent obtained from next of kin.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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