Refractory cardiogenic shock and cardiac arrest from thyroid storm treated with veno arterial extracorporeal membrane oxygenation; A case report

Abstract Background The approach for veno-arterial extracorporeal membrane oxygenation implantation (VA-ECMO) in patients with cardiogenic shock can be either surgical or percutaneous. Complete angio-guided percutaneous implantation and explantation could decrease vascular complications. We sought to describe the initial results of complete percutaneous angio-guided ECMO implantation and explantation using preclosing. Methods All consecutive patients who underwent peripheral femoro-femoral VA-ECMO percutaneous implantation for refractory cardiogenic shock or cardiac arrest were enrolled in a prospective registry (03/2018–12/2020). Percutaneous preclosing using two closing devices (Perclose ProGlide, Abbott) inserted before cannulation was used in both femoral artery and vein. Explantation was performed using a crossover technique under angiographic guidance. The occurrence of vascular complication was recorded. Results Among the 56 patients who underwent percutaneous VA-ECMO implantation for cardiogenic shock or refractory cardiac arrest, 41 underwent preclosing. Femoral vessel cannulation was successful in all patients and total cannulation time was 20 (10–40) min. Weaning from ECMO was possible in 22/41 patients (54%) and 12 (29%) patients were alive at day 30. Significant vascular complications occurred in 2/41 patients. Percutaneous decannulation was performed in 20 patients with 19/20 technical success rate. All femoral arteries and veins were properly closed using the pre-closing devices without bleeding on the angiographic control except for one patient in whom surgical closure of the artery was required. No patient required transfusion for access related significant bleeding and no other vascular complication occurred. Furthermore, no groin infection was observed after full percutaneous implantation and removal of ECMO. Conclusion Emergent complete percutaneous angio-guided VA-ECMO implantation and explantation using pre-closing technique can be an attractive strategy in patients referred for refractory cardiogenic shock.

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Venoarterial Extracorporeal Membrane Oxygenation in Refractory Cardiogenic Shock and Cardiac Arrest

Extracorporeal Membrane Oxygenation: Advances in Therapy ◽

10.5772/63578 ◽

2016 ◽

Cited By ~ 1

Author(s):

Marie-Eve Brunner ◽

Carlo Banfi ◽

Raphaël Giraud

Keyword(s):

Cardiac Arrest ◽

Extracorporeal Membrane Oxygenation ◽

Cardiogenic Shock ◽

Membrane Oxygenation ◽

Venoarterial Extracorporeal Membrane Oxygenation ◽

Refractory Cardiogenic Shock

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Veno-Arterial Extracorporeal Membrane Oxygenation for Refractory Cardiogenic Shock and Cardiac Arrest

Principles and Practice of Cardiothoracic Surgery ◽

10.5772/54719 ◽

2013 ◽

Cited By ~ 1

Author(s):

Francesco Formica ◽

Giovanni Paolini

Keyword(s):

Cardiac Arrest ◽

Extracorporeal Membrane Oxygenation ◽

Cardiogenic Shock ◽

Membrane Oxygenation ◽

Refractory Cardiogenic Shock

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FULL PERCUTANEOUS ANGIO-GUIDED IMPLANTATION AND EXPLANTATION OF VENOARTERIAL EXTRACORPOREAL MEMBRANE OXYGENATION USING PRE-CLOSING IN PATIENTS WITH REFRACTORY CARDIOGENIC SHOCK OR CARDIAC ARREST

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(21)01990-2 ◽

2021 ◽

Vol 77 (18) ◽

pp. 631

Author(s):

Romain Gallet ◽

Anne-Sophie Martin-Tuffreau ◽

Francois Bagate ◽

Madjid Boukantar ◽

Andrea Mangiameli ◽

...

Keyword(s):

Cardiac Arrest ◽

Extracorporeal Membrane Oxygenation ◽

Cardiogenic Shock ◽

Membrane Oxygenation ◽

Venoarterial Extracorporeal Membrane Oxygenation ◽

Refractory Cardiogenic Shock

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Complications of veno-arterial extracorporeal membrane oxygenation for refractory cardiogenic shock or cardiac arrest

The International Journal of Artificial Organs ◽

10.1177/0391398819868483 ◽

2019 ◽

Vol 43 (1) ◽

pp. 37-44 ◽

Cited By ~ 1

Author(s):

Soo Youn Lee ◽

Ki-Hyun Jeon ◽

Hyun Jong Lee ◽

Ji-Bak Kim ◽

Ho-Jun Jang ◽

...

Keyword(s):

Cardiac Arrest ◽

Renal Replacement Therapy ◽

Confidence Interval ◽

Extracorporeal Membrane Oxygenation ◽

Cardiogenic Shock ◽

Odds Ratio ◽

Membrane Oxygenation ◽

Clinical Events ◽

Refractory Cardiogenic Shock ◽

Group 2

Background: The frequency of using veno-arterial extracorporeal membrane oxygenation increased, especially in patients with refractory cardiogenic shock or cardiac arrest. However, data of complications of veno-arterial extracorporeal membrane oxygenation are lacking. This study sought to investigate the incidence of veno-arterial extracorporeal membrane oxygenation complications for acute myocardial infarction patients with refractory cardiogenic shock or cardiac arrest and its relationship with patient survival. Methods: This study included 151 consecutive patients who underwent veno-arterial extracorporeal membrane oxygenation between 2006 and 2018 at a single referral center. We divided the patients into those who survived for 30 days after veno-arterial extracorporeal membrane oxygenation ( n = 57, 38%; group 1) and those who died within 30 days after veno-arterial extracorporeal membrane oxygenation support ( n = 94, 62%; group 2). The major adverse clinical events associated with veno-arterial extracorporeal membrane oxygenation were defined as first occurrence of infection, major bleeding, and stroke. Results: Adverse clinical events associated with veno-arterial extracorporeal membrane oxygenation occurred in 34 (59.6%) and 56 (59.6%) patients in groups 1 and 2, respectively. Group 2 had more patients who underwent new renal replacement therapy (21.1% vs 37.2%, p = 0.037). After multivariable analysis, cardiac arrest was independently associated with 30-day mortality (odds ratio = 3.6; 95% confidence interval = 1.7–7.63; p = 0.001). After excluding patients who died within 48 h after undergoing veno-arterial extracorporeal membrane oxygenation, new renal replacement therapy (odds ratio = 4.47; 95% confidence interval = 1.58–12.61; p = 0.005) and major adverse clinical events (odds ratio = 2.66; 95% confidence interval = 1.01–7.03; p = 0.049) were independently associated with 30-day mortality. Conclusion: Although veno-arterial extracorporeal membrane oxygenation can improve the survival, it is associated with morbidity. Therefore, risk–benefit analysis for veno-arterial extracorporeal membrane oxygenation and prevention of complications are important to improve prognosis.

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Case report: a patient with thyroid storm, refractory cardiogenic shock, and cardiac arrest treated with Lugol's iodine solution and veno-arterial extra corporal membrane oxygenation support

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytab017 ◽

2021 ◽

Vol 5 (2) ◽

Author(s):

Marianne Voll ◽

Kristin Astrid Øystese ◽

Erik Høiskar ◽

Odd Johansen ◽

Cecilie Nyvold ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiogenic Shock ◽

Myocardial Function ◽

Thyroid Storm ◽

Iodine Solution ◽

Lugol’S Iodine ◽

Membrane Oxygenation ◽

Refractory Cardiogenic Shock ◽

Thyroid Hormone Levels ◽

Extra Corporal Membrane Oxygenation

Abstract Background Thyroid storm is a life-threatening condition. Refractory cardiogenic shock and cardiac arrest are rare complications of thyroid storm and the treatment options are limited. Case summary A 35-year- old woman treated for Grave’s disease was admitted with thyrotoxicosis complicated by infection and neutropenia caused by thionamide treatment. After treatment including beta-blockers, steroids, and Lugol’s iodine solution, she went into cardiac arrest. Echocardiography after resuscitation demonstrated severe biventricular heart failure. The patient was in refractory cardiogenic shock with recurrent cardiac arrest and mechanical circulatory support with a veno-arterial extra corporal membrane oxygenation (V-A ECMO) circuit was established. After 2 days on V-A ECMO and supportive treatment with iodine solution, glucocorticosteroids, and levosimendan, her myocardial function recovered and thyroid hormone levels were normalized. Veno-arterial extra corporal membrane oxygenation was discontinued, and the patient was treated with early total thyroidectomy. The patient made a full recovery with no neurological/cognitive impairment, as assessed after 4 weeks. Discussion Adverse reactions to standard treatment of hyperthyroidism contributed to this patient’s development of thyroid storm and the following refractory cardiogenic shock. When she was critically unstable, levosimendan improved myocardial function while inotropic support with dobutamine was ineffective, likely due to prolonged beta-antagonist administration. Temporary support with V-A ECMO, until effective lowering of thyroid hormone levels and improvement in myocardial function were obtained, was life-saving in this young patient and may be considered in refractory cardiogenic shock caused by thyroid storm.

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