Phaeochromocytoma crisis – a rare indication for extracorporeal membrane oxygenation

Chao, Anne; Yeh, Yu-Chang; Yen, Tsan-Shin; Chen, Yih‐Sharng

doi:10.1111/j.1365-2044.2007.05251.x

Cited by 31 publications

(20 citation statements)

References 5 publications

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“…Many authors have reported that these cardiac complications in pheochromocytoma patients were completely reversed by mechanical circulatory support techniques such as ventricular assist devices and extracorporeal life support-without adrenergic blockade or even tumor resection. 2,[7][8][9][10][11]13 Our experience supports this claim: AV node ablation and pacemaker placement stabilized our patient's hemodynamic status within a few hours and normalized her LVEF within a week-well before we entertained the diagnosis of pheochromocytoma.…”

Section: Discussionsupporting

confidence: 68%

Pheochromocytoma-Induced Atrial Tachycardia Leading to Cardiogenic Shock and Cardiac Arrest: Resolution with Atrioventricular Node Ablation and Pacemaker Placement

Shawa¹,

Bajaj²,

Cunningham³

2014

Texas Heart Institute Journal

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Pheochromocytoma should be considered in young patients who have acute cardiac decompensation, even Case ReportIn January 2011, a 38-year-old black woman presented at another hospital with cardiogenic shock (left ventricular ejection fraction [LVEF], <0.15) that did not respond to the placement of an intra-aortic balloon pump. She was transferred by helicopter to our cardiac center for further care. The patient then experienced 2 cardiac arrests and needed cardiopulmonary resuscitation for 5 minutes. A TandemHeart ® Percutaneous Ventricular Assist Device (CardiacAssist, Inc.; Pittsburgh, Pa) was inserted emergently. A 12-lead electrocardiogram confirmed atrial tachycardia (Fig. 1A). A trial of intravenous metoprolol caused a complete cessation of blood flow from the TandemHeart device. The patient responded to glucagon and intravenous fluids. Comprehensive electrophysiologic studies revealed multifocal atrial tachycardia and junctional ectopic tachycardia, which were treated with radiofrequency ablation of the atrioventricular (AV) node and the placement of a temporary pacemaker. This treatment dramatically stabilized the patient's hemodynamic status and within a few hours improved her LVEF to 0.25-0.30. Consequently, the patient was weaned off vasopressors, and the TandemHeart was removed. The patient subsequently developed a junctional escape rhythm at 78 beats/min and AV dissociation (Fig. 1B). Her blood pressure was maintained in the normal range after tapering of the vasopressors.

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Section: Discussionsupporting

confidence: 68%

Pheochromocytoma-Induced Atrial Tachycardia Leading to Cardiogenic Shock and Cardiac Arrest: Resolution with Atrioventricular Node Ablation and Pacemaker Placement

Shawa¹,

Bajaj²,

Cunningham³

2014

Texas Heart Institute Journal

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“…Th e preoperative requirement of ECMO due to crisis, as in our patient, is rare, but has been previously described (2,6,7). Th e patient's clinical history and large adrenal mass pointed the team toward the correct cause for her hypertensive emergency.…”

Section: Case Reportmentioning

confidence: 52%

Hypertensive Crisis Secondary to Pheochromocytoma

Greenleaf

Griffin

Shake

et al. 2017

Baylor University Medical Center Proceedings

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Pheochromocytoma is an uncommon tumor of the adrenal glands that can present with headaches, sweating, palpitations, and paroxysmal hypertension. Pheochromocytoma crisis can lead to cardiomyopathy, pulmonary edema, and even total circulatory collapse. We describe a patient with hypoxic respiratory failure requiring extracorporeal membrane oxygenation to stabilize until the pheochromocytoma was discovered and treated. P heochromocytoma is an uncommon tumor of the adrenal glands that can present with headaches, sweating, palpitations, and paroxysmal hypertension (1). Surgical excision is the only curative option. Preoperative management includes alpha blockade and volume expansion followed by beta blockade to treat tachycardia after suffi cient alpha blockade has been established in order to prevent pheochromocytoma crisis. Th is crisis can usually be prevented if the pheochromocytoma is known, but sometimes this hypertensive crisis is the initial manifestation of the disorder. A crisis can lead to cardiomyopathy, pulmonary edema, and even total circulatory collapse (2). We describe a patient with hypoxic respiratory failure requiring extracorporeal membrane oxygenation (ECMO) to stabilize until the pheochromocytoma was discovered and treated. CASE REPORTA 37-year-old woman initially presented to an outside hospital with a chief complaint of nausea, vomiting, and abdominal pain. In the emergency department waiting room, she had a syncopal episode and was found to have a pulse oximeter oxygen saturation of 80% and hypertension with a blood pressure of 200/100 mm Hg. She was intubated because her hypoxia could not be improved with noninvasive methods and was then transferred to our tertiary medical center. Upon admission, an arterial blood gas showed a pH of 6.8, partial pressure of carbon dioxide of 51, partial pressure of oxygen of 71, and lactate of 10 mmoL/L. She had progressively worsening oxygenation and ventilation despite increasing ventilatory support. Neuromuscular-blocking agents and multiple ventilator modes and maneuvers including airway pressure release ventilation were unsuccessful in improving her respiratory status. Her initial chest radiograph is shown in Figure 1. During this time she also had extreme blood pressure lability with systolic pressures ranging from 80 to 200 mm Hg. Because she could not be adequately ventilated and oxygenated, the cardiothoracic surgical service was consulted. Th e patient was placed on veno-venous ECMO with a 23Fr femoral venous cannula and a 21Fr right internal jugular venous cannula. While stabilized on veno-venous ECMO, ventilation, oxygenation, and metabolic acidosis improved over the next few days.Her family disclosed that the patient had a long history of refractory hypertension with failed medical management, intermittent headaches, and palpitations. Th e family also reported that the patient had not taken any of her blood pressure medications during the 2 weeks prior to her presentation because she could no longer aff ord them. Computed tomography angiography...

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“…To our knowledge, there have been only 3 reports of using PCPS to manage the cardiogenic shock induced by pheochromocytoma. [7][8][9] Although it has not been used frequently, the PCPS has potential advantages in the management of catecholamineinduced cardiogenic shock. First, it can restore arterial blood flow regardless of the heart rate or arrhythmia.…”

Section: Discussionmentioning

confidence: 99%

Pheochromocytoma-Induced Cardiogenic Shock Rescued by Percutaneous Cardiopulmonary Bypass System

Park

Kim

Kwak

et al. 2009

Circ J

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heochromocytoma is a rare cause of cardiogenic shock encountered in emergency departments. 1 The diagnosis is often delayed or not made until postmortem. 2 Even if a proper diagnosis has been made, the management of cardiogenic shock caused by pheochromocytoma is frequently unsuccessful because reducing endogenous catecholamine levels and maintaining arterial blood pressure are difficult or sometimes impossible. Although there are reports in which intraaortic balloon pumping (IABP) was used successfully for the treatment of medically unresponsive patients, not all are successful. 3,4 Percutaneous cardiopulmonary bypass system (PCPS) may help overcome this devastating clinical condition. PCPS is a more powerful circulatory device than IABP and can be used in patients with cardiogenic shock or arrest. The assembly and manipulation of the device is simplified, so rapid setup is possible. Using the Seldinger technique the cannulas for PCPS can be introduced percutaneously through the femoral artery and vein. We present a case in which pheochromocytoma induced cardiogenic shock was successfully managed with PCPS. Case ReportA 41-year-old man was admitted to the emergency department because of palpitation and abdominal pain. He had a history of intermittent headache and palpitation but had never undergone a medical evaluation. His initial blood pressure was 140/100 mmHg and heart rate was 171 beats/min. The admission electrocardiogram (ECG) showed narrow-QRS tachycardia with elevated ST-segment in leads V5, V6, II, III and aVF ( Figure 1A). Vagal maneuvers failed to terminate the tachycardia and intravenous administration of adenosine (6 mg) and verapamil (5 mg) had no effect. The troponin I and CK-MB levels were 6.27 ng/ml (normal range ≤0.05) and 26 ng/ml (normal range ≤3.6 ng/ml), respectively. Because of the elevated cardiac enzymes and ischemic findings on ECG, the initial impression was acute myocardial infarction and emergency PCI was tried. However, coronary angiography showed no coronary artery abnormality. To determine the cause of the abdominal pain, an abdominal CT scan was done, which revealed a hypervascular left adrenal mass (Figure 2). Meanwhile, his blood pressure decreased to 80/40 mmHg and the patient was transferred to the intensive care unit for mechanical ventilation. Echocardiography showed global hypokinesia with an ejection fraction of 20%. Dobutamine (15 μg · kg -1 · min -1 ) and domapine (10 μg · kg -1 · min -1 ) were infused, but the blood pressure did not increase. An IABP was inserted through the right common femoral artery and circulation was assisted with 1:2 counterpulsation. His heart rate was continuously high (168 high/min) and blood pressure dropped further to 53/41 mmHg despite the infusion of inotropics. PaO2 (from the right radial artery) was 51 mmHg with FiO2 100% and peak end-expiratory pressure of 5 cm H2O. Pulmonary edema was present on his chest X-ray (Figure 3). We decided to use a PCPS (EBS, Terumo, Tokyo, Japan). After obtaining informed consent from the patient's family...

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Phaeochromocytoma crisis – a rare indication for extracorporeal membrane oxygenation

Cited by 31 publications

References 5 publications

Pheochromocytoma-Induced Atrial Tachycardia Leading to Cardiogenic Shock and Cardiac Arrest: Resolution with Atrioventricular Node Ablation and Pacemaker Placement

Pheochromocytoma-Induced Atrial Tachycardia Leading to Cardiogenic Shock and Cardiac Arrest: Resolution with Atrioventricular Node Ablation and Pacemaker Placement

Hypertensive Crisis Secondary to Pheochromocytoma

Pheochromocytoma-Induced Cardiogenic Shock Rescued by Percutaneous Cardiopulmonary Bypass System

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