Hangzhou Geriatric Hospital, Hangzhou First People's Hospital Group, Hangzhou, China.
Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Perfusion. 2023 Mar;38(2):228-235. doi: 10.1177/02676591211049314. Epub 2021 Oct 7.
In this article, we aimed to elaborate on perioperative and complication management in treatment of pheochromocytoma crisis with extracorporeal membrane oxygenation (ECMO).
We report a case of relatively rare grant paraganglioma-induced pheochromocytoma crisis leading to severe circulatory failure, treated with venoarterial extracorporeal membrane oxygenation (V-A ECMO) as a bridge to curative adrenalectomy. Weaning of ECMO was followed by successful surgical removal of the tumor, and patient survival. However, distal ischemia of the cannulated leg occurred during ECMO operation, which eventually led to amputation. In addition, the patient developed new cerebral infarction and left hemiplegia, half a month after paraganglioma resection.
We believe that patients with pheochromocytoma crisis, who cannot maintain blood circulation, are eligible for V-A ECMO treatment. Moreover, care should be taken to prevent thrombosis and individualized and precise blood pressure management targets. Early detection and treatment of thrombosis is imperative to long-term prognosis of patients with ECMO.
本文旨在阐述体外膜肺氧合（ECMO）在治疗嗜铬细胞瘤危象中的围手术期和并发症管理。
我们报告了一例罕见的格兰特副神经节瘤引起的嗜铬细胞瘤危象导致严重循环衰竭，通过静脉-动脉体外膜肺氧合（V-A ECMO）作为桥接治疗性肾上腺切除术。ECMO 脱机后成功切除肿瘤，患者存活。然而，在 ECMO 手术过程中出现了插管腿的远端缺血，最终导致截肢。此外，在副神经节瘤切除后半个月，患者出现新的脑梗死和左侧偏瘫。
我们认为不能维持血液循环的嗜铬细胞瘤危象患者适合 V-A ECMO 治疗。此外，应注意预防血栓形成，并制定个体化和精确的血压管理目标。早期发现和治疗血栓形成对于 ECMO 患者的长期预后至关重要。
