title: Highlighting Indication of extracorporeal membrane oxygenation in endocrine emergencies.
abstract: Extracorporeal membrane oxygenation (ECMO) has been repeatedly used to rescue patients with cardiopulmonary arrest. However, its clinical utility in endocrine emergencies remains unclear. Herein, we describe a case series of 12 patients presenting with refractory shock secondary to endocrine emergencies who were rescued by ECMO support. Patients were identified between 2005 and 2012 from our ECMO registry. The diagnostic distribution was as follows: pheochromocytoma crisis (n = 4), thyroid storm (n = 5), and diabetic ketoacidosis (n = 3). The initial presentation of pheochromocytoma crisis was indistinguishable from acute myocardial infarction (AMI) and frequently accompanied by paroxysmal hypertension and limb ischemia. Thyroid storm was characterized by hyperbilirubinemia and severe gastrointestinal bleeding, whereas neurological symptoms were common in diabetic ketoacidosis. The clinical outcomes of patients with endocrine emergencies were compared with those of 80 cases with AMI who received ECMO because of cardiogenic shock. The cardiac function and the general conditions showed a significantly faster recovery in patients with endocrine emergencies than in those with AMI. We conclude that ECMO support can be clinically useful in endocrine emergencies. The screening of endocrine diseases should be considered during the resuscitation of patients with refractory circulatory shock.
authors: Department of Anesthesiology, National Taiwan University Hospital, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors: Anne
authors: A
authors: Chao
authors: Department of Surgery, National Taiwan University Hospital, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors: Chih-Hsien
authors: CH
authors: Wang
authors: Department of Surgery, National Taiwan University Hospital, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors: Hao-Chun
authors: HC
authors: You
authors: Department of Surgery, National Taiwan University Hospital, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors: Nai-Kwoun
authors: NK
authors: Chou
authors: Department of Surgery, National Taiwan University Hospital, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors: Hsi-Yu
authors: HY
authors: Yu
authors: Department of Surgery, National Taiwan University Hospital, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors: Nai-Hsin
authors: NH
authors: Chi
authors: Department of Surgery, National Taiwan University Hospital, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors: Shu-Chien
authors: SC
authors: Huang
authors: Department of Surgery, National Taiwan University Hospital, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors: I-Hui
authors: IH
authors: Wu
authors: Department of Surgery, National Taiwan University Hospital, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors: Li-Jung
authors: LJ
authors: Tseng
authors: Department of Surgery, National Taiwan University Hospital, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors: Ming-Hsien
authors: MH
authors: Lin
authors: Department of Surgery, National Taiwan University Hospital, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors: Yih-Sharng
authors: YS
authors: Chen
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000628:therapy; D000328:Adult; D000368:Aged; D003710:Demography; D016883:Diabetic Ketoacidosis / Q000628:therapy; D004630:Emergencies; D004703:Endocrine System / Q000473:pathology*; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy; D010673:Pheochromocytoma / Q000473:pathology / Q000628:therapy; D013958:Thyroid Crisis / Q000628:therapy