Journal: Anaesthesia 63(1):86-88, 2008. 5 References
Reprint: Dept of Anaesthesia and Intensive Care, National Taiwan University Hospital, 7, Chung-Shan S. Road, Taipei, 100, Taiwan (A Chao, MD)
Faculty Disclosure: Abstracted by L. Easley, who has nothing to disclose.
Pheochromocytomas are catecholamine-secreting tumors that may cause a wide range of clinical presentations from the usual clinical findings of paroxysms of hypertension, headache, and palpita-tions to rare acute adrenergic cardiomyopathy leading to fatal cardiopulmonary collapse. Cardiogenic shock secondary to an undiagnosed pheochromocytoma carries a high mortality.
An effective resuscitation modality is required to achieve a successful outcome in patients presenting with life-threatening complications of a pheochromo-cytoma. The authors present the successful resusci-tation of a patient presenting with a pheochromo-cytoma crisis that mimicked acute myocardial infarction, by using extracorporeal membrane oxygenation. A 42-year-old man was referred to the hospital with a suspected acute myocardial infarction (AMI). An echocardiograph revealed significant left ventricular dysfunction, with a left ventricular ejection fraction of 20%. An emergency coronary angiogram was performed, which revealed patent coronary arteries. Due to refractory cardiogenic shock, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) was initiated using his left femoral vessels. A membrane oxygenator was placed for extracorporeal oxygenation and gas exchange.
Over the next 3 days, echocardiography showed some recovery of the patient’s myocardial function. Because of widely fluctuating blood pressures, pheochromocytoma was suspected and 24-hr urine catecholamines were collected to confirm the diagnosis. Phenoxybenzamine was given nasogastrically, the patient’s clinical condition slowly improved, and he was weaned off ECMO and the intra-aortic balloon pump (IABP) by day 7. Following laparoscopic left adrenalectomy, histology confirmed a pheochromocytoma with central hemorrhage occupying most of the left adrenal gland.
In the present case, ECMO provided both cardiac and pulmonary support, allowing the patient to recover, and giving the clinicians time to identify the underlying problem. To the authors’ knowledge, this is the first successful case where VA-ECMO has been used as the only mechanical life support during the resuscitation of a patient with cardiopulmonary collapse secondary to a pheochromocytoma. |
