ID:86 FC-D02-5 Veno-Arterial ECMO for Phaeochromocytoma-Induced Refractory Cardiogenic Shock: A Case Report and Literature Review

Background: Phaeochromocytoma is a rare cause of fulminant cardiogenic shock with diagnostic and therapeutic challenges acutely. Case reports have positively described mechanical circulatory support in patients with phaeochromocytoma crises and refractory cardiogenic shock. We present two patients treated with veno-arterial extracorporeal membrane oxygenation (V-A ECMO) as a bridge to haemodynamic stabilisation, alpha adrenergic blockade, and definitive surgical management. Clinical Course: Patient A, a 32 year old female, presented with hypertensive crisis, pulmonary edema and severe left ventricular dysfunction, deteriorated into cardiogenic shock despite escalating inopressors, and received peripheral V-A ECMO. Computed tomography (CT) showed a right adrenal lesion, and plasma metanephrines were elevated. Short acting alpha blockade was introduced gradually during ECMO. Left ventricular function recovered and she was liberated from ECMO after 9 days, discharged home and underwent a delayed adrenalectomy. Patient B, a 26 year old male, presented with undifferentiated shock initially treated as sepsis. CT demonstrated a right adrenal lesion. He developed refractory ventricular tachyarrythmias and recurrent cardiac arrests, achieved return of spontaneous circulation with persisting cardiogenic shock and received peripheral V-A ECMO. After stabilisation, he received cautious alpha blockade and was liberated from ECMO 9 days later. He achieved neurological and cardiac recovery, was discharged home, and later underwent an adrenalectomy. Discussion: These cases illustrate the challenge of initiating and escalating alpha blockade in ECMO-dependent patients with phaeochromocytoma-induced ventricular dysfunction. Although appearing physiologically contradictory, treatment of catecholamine excess with sympathetic blockade is essential, and V-A ECMO provides a platform to support haemodynamics and ventricular function while doing so. Conclusion: V-A ECMO may provide a lifesaving bridge to recovery by facilitating haemodynamic control, safe initiation of sympathetic blockade and allowing delayed curative surgery in phaeochromocytoma crisis.