Extracorporeal Membrane Oxygenation Rescues Thyrotoxicosis-Related Circulatory Collapse

Hsu, Li-Min; Ko, W.J.; Wang, Chih‐Hsien

doi:10.1089/thy.2010.0230

Cited by 15 publications

(10 citation statements)

References 20 publications

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“…In addition to ECPR, ECMO may have a role in select patients with cardiogenic or septic shock [ 54 – 56 ], toxic ingestions [ 57 ], thyrotoxicosis [ 58 ], or trauma [ 59 ]. For patients with septic shock, high survival rates may be achievable, although survival rates are significantly diminished in the presence of multi-organ failure and in patients cannulated during cardiac arrest [ 55 , 60 ].…”

Section: Current Applicationsmentioning

confidence: 99%

Extracorporeal membrane oxygenation (ECMO) for critically ill adults in the emergency department: history, current applications, and future directions

et al. 2015

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Extracorporeal membrane oxygenation (ECMO) is a mode of extracorporeal life support that augments oxygenation, ventilation and/or cardiac output via cannulae connected to a circuit that pumps blood through an oxygenator and back into the patient. ECMO has been used for decades to support cardiopulmonary disease refractory to conventional therapy. While not robust, there are promising data for the use of ECMO in acute hypoxemic respiratory failure, cardiac arrest, and cardiogenic shock and the potential indications for ECMO continue to increase. This review discusses the existing literature on the potential use of ECMO in critically ill patients within the emergency department.

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Section: Current Applicationsmentioning

confidence: 99%

Extracorporeal membrane oxygenation (ECMO) for critically ill adults in the emergency department: history, current applications, and future directions

et al. 2015

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“…In 2011, Hsu et al. ( 20 ) first reported a series with the use of supportive ECMO ranging from 19-114 hours in four cases of thyrotoxicosis-induced cardiovascular collapse. Three patients survived, with normalization of thyroid function and improved cardiovascular function.…”

Section: Discussionmentioning

confidence: 99%

“…This is thought to be reversible with treatment with thyrotoxicosis, with a small study showing improving in LVEF from 28% to 55% ( 40 ). Cardiomyopathy and LV dysfunction, on the other hand, are only seen in 1% ( 20 , 41 ). HF with low CO has been reported with prolonged severe hyperthyroidism, consequent to persistent tachycardia, and pathologic increase in cardiac workload with demand-supply mismatch ( 42 ).…”

Section: Discussionmentioning

confidence: 99%

Crash Landing of Thyroid Storm: A Case Report and Review of the Role of Extra-Corporeal Systems

et al. 2021

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Thyroid storm is a rare but life-threatening endocrinological emergency with significant mortality ranging from 10-30% with multi-organ involvement and failure. In view of the rarity of this condition and efficacy of established first line medical treatment, use of extra-corporeal treatments are uncommon, not well-studied, and its available evidence exists only from case reports and case series. We describe a 28-year-old man who presented with an out-of-hospital cardiac arrest secondary to thyroid storm. Despite conventional first-line pharmacotherapy, he developed cardiogenic shock and circulatory collapse with intravenous esmolol infusion, as well as multi-organ failure. He required therapeutic plasma exchange, concurrent renal replacement therapy, and veno-arterial extra-corporeal membrane oxygenation, one of the few reported cases in the literature. While there was clinical stabilization and improvement in tri-iodothyronine levels on three extra-corporeal systems, he suffered irreversible hypoxic-ischemic brain injury. We reviewed the use of early therapeutic plasma exchange and extra-corporeal membrane oxygenation, as well as the development of other novel extra-corporeal modalities when conventional pharmacotherapy is unsuccessful or contraindicated. This case also highlights the complexities in the management of thyroid storm, calling for caution with beta-blockade use in thyrocardiac disease, with close monitoring and prompt organ support.

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“…Keywords cardiogenic shock, cardiopulmonary resuscitation, long-term continuous-flow biventricular support, long-term mechanical circulatory support, short-term mechanical circulatory support [12,14,18,31 ,44,50-52], in acute decompensation of end-stage chronic heart failure (CHF) [16,29,45,53], in acute heart failure due to congenital heart disease [16,40,42,43], in pharmacologic suicide attempt [29], and in thyrotoxicosis-related circulatory collapse [54].…”

Section: Recent Findingsmentioning

confidence: 99%

Mechanical assistance of the circulation during cardiogenic shock

Pitsis

Visouli

2011

Current Opinion in Critical Care

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Although MCS can be life saving in cardiogenic shock, the results are still suboptimal. Mortality is associated with the critical presupport state and the adverse events during MCS. Early initiation of support that meets the patient's requirements, potent support in the early phase, adverse event prevention, global combined management (surgical, interventional, medical), balanced support duration, bridging to further therapeutic modalities including heart transplantation or longer-term support, and advanced technology could offer improved results.

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Extracorporeal Membrane Oxygenation Rescues Thyrotoxicosis-Related Circulatory Collapse

Abstract: Patients experiencing heart failure due to severe thyrotoxicosis should be admitted to intensive care unit for close hemodynamic monitor. In addition, mechanical circulatory support such as ECMO should be provided immediately once circulatory collapse occurs.

Cited by 15 publications

References 20 publications

Extracorporeal membrane oxygenation (ECMO) for critically ill adults in the emergency department: history, current applications, and future directions

Extracorporeal membrane oxygenation (ECMO) for critically ill adults in the emergency department: history, current applications, and future directions

Crash Landing of Thyroid Storm: A Case Report and Review of the Role of Extra-Corporeal Systems

Mechanical assistance of the circulation during cardiogenic shock

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