Community health workers have been used in health centers for several decades. Known by various names (e.g., community health advisors, outreach workers, promotoras), they are trusted community members providing informal community-based health-related services and establishing vital links between health providers and the community. They perform many functions, including outreach and case finding, health education, translation, patient transportation, and case management (under the supervision of a nurse or social worker). This article, based on a study of community health worker programs at seven sites, is intended to share the lessons learned that could be helpful to other program managers and to examine the outcomes of such programs.

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...