Department of General, Digestive and Endocrine Surgery, IRCAD/EITS, University Hospital, Strasbourg 67091, France.
Am J Emerg Med. 2012 Jul;30(6):1017.e1-3. doi: 10.1016/j.ajem.2011.05.006. Epub 2011 Jul 8.
The aim of this study is to report the case of a catecholamine-induced cardiogenic shock bridged to curative adrenalectomy using extracorporeal membrane oxygenation (ECMO) and medical management. A 37-year-old woman presented an acute cardiogenic shock due to a left-sided pheochromocytoma. Echocardiography revealed a severe global hypokinesia with a left ventricular ejection fraction of 15%. Despite maximal ionotropic support, adequate perfusion could not be achieved; and ECMO was used to bridge the patient during medical management with calcium-channel blockers. The left ventricular ejection fraction improved to 65%, and ECMO was discontinued after 11 days. An open left adrenalectomy was performed 10 days after ECMO. At 1-year follow-up, the patient is in good health with normal cardiac function. Pheochromocytomas can present with dramatic cardiovascular collapse. With timely diagnosis and medical therapy, followed by surgical resection, the cardiovascular effects can be reversed; and the condition, cured. Young patients with catecholamine-induced cardiac failure refractory to medical therapy are ideal candidates for short-term ECMO support, as the underlying cause is imminently reversible.
本研究旨在报告一例使用体外膜氧合（ECMO）和药物治疗桥接儿茶酚胺诱导的心源性休克至治愈性肾上腺切除术的病例。一名 37 岁女性因左侧嗜铬细胞瘤发生急性心源性休克。超声心动图显示严重的整体运动功能减退，左心室射血分数为 15%。尽管给予了最大的正性肌力支持，但仍无法实现充分灌注；并使用 ECMO 在使用钙通道阻滞剂进行药物治疗期间为患者提供桥接。左心室射血分数提高至 65%，ECMO 在 11 天后停用。ECMO 后 10 天进行了开放性左肾上腺切除术。在 1 年的随访中，患者身体健康，心功能正常。嗜铬细胞瘤可引起剧烈的心血管崩溃。及时诊断和药物治疗，继以手术切除，可以逆转心血管效应；并治愈该疾病。对药物治疗难治的儿茶酚胺诱导性心力衰竭的年轻患者是短期 ECMO 支持的理想人选，因为潜在病因是可以立即逆转的。
