Extracorporeal life support for phaeochromocytoma-induced cardiogenic shock: a systematic review

Abstract

Introduction: Phaeochromocytoma is a catecholamine-secreting tumour associated with clinical presentation ranging from paroxysmal hypertension to intractable cardiogenic shock. Extracorporeal life support, in veno-arterial mode, application in refractory acute heart dysfunction is sharply increasing worldwide. However, its clinical utility in phaeochromocytoma-induced cardiogenic shock remains still unclear. Methods: A systematic review of published reports was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Statement. Searches were accomplished on PubMed, Embase and Google Scholar to identify articles describing the use of extracorporeal life support in the setting of phaeochromocytoma-induced cardiogenic shock (PROSPERO: CRD42019125225). Results: Thirty-five reports, including 62 patients supported with extracorporeal life support because of intractable phaeochromocytoma crisis, were included for the analysis. Almost all the subjects underwent peripheral cannulation for extracorporeal life support. The median duration of the mechanical circulatory support was 5 days, and most of the patients recovered normal myocardial function (left ventricular ejection fraction ⩾50%). In-hospital survival was 87%. Phaeochromocytoma was removed surgically during extracorporeal life support in 10 patients (16%), while in the remaining after haemodynamic stabilization and weaning from the mechanical support. Conclusion: Successful management of phaeochromocytoma-induced cardiogenic shock depends on prompt recognition and immediate treatment of shock. In this scenario, extracorporeal life support may play a significant role allowing cardiac and end-organ recovery and giving time for accurate diagnosis and specific treatment.

Pulsatility Protects the Endothelial Function During Extracorporeal Membrane Oxygenation

“…Extracorporeal membrane oxygenation (ECMO), a life-saving approach, is essentially important for the treatment of patients with severe cardiorespiratory failure, including those extremely critical patients [1], however, overall survival rate for extracorporeal life support (ECLS) is increasing sluggishly over the past ten years [2]. While ECLS rescues the cardiorespiratory sytem, microcirculatory malperfusion easily occurrs when prolonged ECLS is executed as the continuous non-physiological ow impairs the microcirculatory function [3].…”

Pulsatility Protects the Endothelial Function during Extracorporeal Membrane Oxygenation

“…Extracorporeal membrane oxygenation (ECMO), a life-saving approach, is essentially important for the treatment of patients with severe cardiorespiratory failure, including those extremely critical COVID-19 patients [1], however, overall survival rate for extracorporeal life support (ECLS) is increasing sluggishly over the past ten years [2]. While ECLS rescues the cardiorespiratory sytem, microcirculatory malperfusion easily occurrs when prolonged ECLS is executed as the continuous non-physiological ow impairs the microcirculatory function [3].…”

Left ventricular venting for extracorporeal life support in pheochromocytoma: Letter to the Editor – response

“…We thank Pocar and associates for their interest and comments 1 about our paper 2 on the use of ECMO in pheochromocytoma-related crisis. We would like also to congratulate them for the outstanding results obtained in their two patients, particularly for the one on cardiac arrest at the moment of ECMO implant.…”