title: Pheochromocytoma Crisis in the ICU: A French Multicenter Cohort Study With Emphasis on Rescue Extracorporeal Membrane Oxygenation.
abstract: OBJECTIVE
  To describe the characteristics, management, and outcome of patients admitted to ICUs for pheochromocytoma crisis.
  
  
  METHODS
  A 16-year multicenter retrospective study.
  
  
  METHODS
  Fifteen university and nonuniversity ICUs in France.
  
  
  METHODS
  Patients admitted in ICU for pheochromocytoma crisis.
  
  
  METHODS
  None.
  
  
  RESULTS
  We included 34 patients with a median age of 46 years (40-54 yr); 65% were males. At admission, the median Sequential Organ Failure Assessment score was 8 (4-12) and median Simplified Acute Physiology Score II 49.5 (27-70). The left ventricular ejection fraction was consistently decreased with a median value of 30% (15-40%). Mechanical ventilation was required in 23 patients, mainly because of congestive heart failure. Vasoactive drugs were used in 23 patients (68%) and renal replacement therapy in eight patients (24%). Extracorporeal membrane oxygenation was used as a rescue therapy in 14 patients (41%). Pheochromocytoma was diagnosed by CT in 33 of 34 patients. When assayed, urinary metanephrine and catecholamine levels were consistently elevated. Five patients underwent urgent surgery, including two during extracorporeal membrane oxygenation. Overall ICU mortality was 24% (8/34), and overall 90-day mortality was 27% (9/34). Crude 90-day mortality was not significantly different between patients managed with versus without extracorporeal membrane oxygenation (22% vs 30%) (p = 0.7) despite higher severity scores at admission in the extracorporeal membrane oxygenation group.
  
  
  CONCLUSIONS
  Mortality is high in pheochromocytoma crisis. Routinely considering this diagnosis and performing abdominal CT in patients with unexplained cardiogenic shock may allow an earlier diagnosis. Extracorporeal membrane oxygenation and adrenalectomy should be considered as a therapeutic in most severe cases.
authors.affiliation: 1Service de Réanimation Médicale Polyvalente, Centre Hospitalier Public du Cotentin, Cherbourg-en-Cotentin, France.2Service de Réanimation Médicale, Centre Hospitalier Universitaire, Avenue de la Côte de Nacre, Caen, France.3Service de Réanimation Médicale et Médecine hyperbare, Centre Hospitalier Universitaire, Angers, France.4Service de Réanimation Médicale, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France.5Service d'Anesthésie Réanimation, Groupement des Hôpitaux de l'Institut Catholique de Lille, Lille, France.6Service de Réanimation Chirurgicale, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France.7Service de Réanimation Médico-chirurgicale, Centre Hospitalier Universitaire Dupuytren, Limoges Cedex, France.8Département d'Anesthésie-Réanimation, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France.9Service de Réanimation Médicale et infectieuse, Hôpital Bichat Claude Bernard, Assistance Publique-Hôpitaux de Paris, Paris, France.10Service de Réanimation Médicale, Centre Hospitalier Universitaire, Rouen, France.11Service de Réanimation Médico-chirurgicale, Centre Hospitalier de Longjumeau, Longjumeau, France.12Service de Réanimation Médicale, Hôpital Brabois, Centre Hospitalier Universitaire, Vandoeuvre les Nancy, France.13Service de Réanimation Polyvalente, Hôpital Félix-Guyon, Centre Hospitalier Universitaire, Saint-Denis, La Réunion, France.14Service de Réanimation Polyvalente, Centre Hospitalier de Cholet, Cholet Cedex, France.15Service de Réanimation Polyvalente, Centre Hospitalier Robert Ballanger, boulevard Robert Ballanger, Aulnay sous Bois, France.16Service de Réanimation Polyvalente, Centre Hospitalier Versailles, Le Chesnay, France.17Service de Médecine intensive, Centre Hospitalier Marc Jacquet, Melun cedex, France.18Service d'Anesthésie Réanimation, Centre Hospitalier Universitaire, Caen, France.19Université de Caen Normandie, Esplanade de la Paix, Caen, France.20Service de Réanimation Médicale, CHU Grenoble Alpes, Grenoble, France.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Sauneuf
authors.forename: Nicolas
authors.initials: N
authors.lastname: Chudeau
authors.forename: Benoit
authors.initials: B
authors.lastname: Champigneulle
authors.forename: Claire
authors.initials: C
authors.lastname: Bouffard
authors.forename: Marion
authors.initials: M
authors.lastname: Antona
authors.forename: Nicolas
authors.initials: N
authors.lastname: Pichon
authors.forename: David
authors.initials: D
authors.lastname: Marrache
authors.forename: Romain
authors.initials: R
authors.lastname: Sonneville
authors.forename: Antoine
authors.initials: A
authors.lastname: Marchalot
authors.forename: Camille
authors.initials: C
authors.lastname: Welsch
authors.forename: Antoine
authors.initials: A
authors.lastname: Kimmoun
authors.forename: Bruno
authors.initials: B
authors.lastname: Bouchet
authors.forename: Elmi
authors.initials: E
authors.lastname: Messai
authors.forename: Sylvie
authors.initials: S
authors.lastname: Ricome
authors.forename: David
authors.initials: D
authors.lastname: Grimaldi
authors.forename: Jonathan
authors.initials: J
authors.lastname: Chelly
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Hanouz
authors.forename: Alain
authors.initials: A
authors.lastname: Mercat
authors.forename: Nicolas
authors.initials: N
authors.lastname: Terzi
mesh_terms: D018806:APACHE; D000310:Adrenal Gland Neoplasms / Q000401:mortality / Q000628:therapy*; D000328:Adult; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D005602:France; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D063305:Organ Dysfunction Scores; D010673:Pheochromocytoma / Q000401:mortality / Q000628:therapy*; D017582:Renal Replacement Therapy / Q000379:methods; D012121:Respiration, Artificial / Q000379:methods; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014662:Vasoconstrictor Agents / Q000008:administration & dosage; D014665:Vasodilator Agents / Q000008:administration & dosage
chemical_list: D014662:Vasoconstrictor Agents; D014665:Vasodilator Agents