Recently, the Department of Critical Care Medicine of Dezhou Hospital of Qilu Hospital of Shandong University successfully treated a rare patient with pheochromocytoma and was complicated with catecholamine cardiomyopathy.
ECMO, also known as Extracorporeal membrane oxygenation , is known as a life-saving "artifact". It is mainly used to provide continuous external breathing and circulation to patients with severe cardiopulmonary failure to maintain the patient's life and create opportunities for the treatment of the primary disease. The successful treatment of this case reflects the continuous improvement of the comprehensive treatment capabilities of the Dezhou Hospital of Qilu Hospital of Shandong University, and also marks that the hospital's critical care medicine ECMO team has become more and more mature.
Data picture
Not long ago, Shandong University Qilu Hospital accepted a critically ill pregnant woman. The patient was in a coma when he was sent to the emergency department and his blood pressure could not be measured. Dr. Sui Weinan and the emergency department doctor of the Department of Critical Care Medicine immediately transferred to ICU after emergency treatment.
In the ICU, Zhao Aichao, Yu Jiangtao, Zhang Chunyong and other medical staff in the Department of Critical Care Medicine have been in place. After preliminary rescue and treatment, the patient's blood pressure has rebounded, but the heart displacement is low, and the heart rate reaches 180 beats per minute. Ultrasound shows that the left ventricular movement has been significantly weakened, and the ejaculation fraction of is only 30%.
After multidisciplinary consultation, the patient was initially considered to have explosive myocarditis and cardiogenic shock. In the case of poor response to cardiac drugs and the patient's condition gradually deteriorated, Xia Jianguang, director and chief physician of the hospital's critical care medicine department, decided to implement VA-ECMO assisted treatment immediately.
With the close cooperation of the ECMO team of the critical care medicine department, the pre-charge, arteriovenous puncture catheterization, connection and operation of ECMO were successfully completed. Then the patient's blood pressure, heart rate, and oxygenation were significantly improved, and the lactic acid was significantly reduced.
In order to adjust the patient's coagulation status and ECMO support at any time, Dr. Zhao Aichao guarded the ward all night and adjusted the equipment parameters according to the patient's indicators at any time to ensure the safety of the patient.
Treatment process
However, on the third day of successful application of ECMO, the patient's blood pressure experienced roller coaster fluctuations, rising and falling. The critical care medicine team realized that there might be other reasons for the patient's condition. After an intensive abdominal CT examination, the doctor found a tumor in the patient's left adrenal gland and highly suspected the possibility of pheochromocytoma. After blood-exported catecholamine testing, the patient was diagnosed with pheochromocytoma and catecholamine cardiomyopathy.
Then, after 5 days of symptomatic treatment and ECMO assistance, the patient's blood pressure gradually stabilized, his heart movement was significantly improved, and his ejaculation fraction exceeded 50%.
After comprehensive evaluation, the patient was successfully evacuated from ECMO. After the withdrawal of the aircraft, the patient's vital signs were stable. On the 9th day, the patient successfully took off the ventilator and removed the tracheal intubation. After 48 hours of observation, the patient was transferred to the urology department and prepared for left adrenal pheochromocytoma resection after the conditions were mature. After evaluation by the obstetrician, the fetus in the patient is in good condition.
"ECMO technology is an internationally recognized top emergency technology in the field of critical care medicine. It represents the hospital's ability and level of emergency and critical care treatment, and is also the last hope for patients with terminal respiratory and circulatory failure." Xia Jianguang said.
Further reading
Catecholamine cardiomyopathy has an incidence rate of about 11% in patients with pheochromocytoma. If cardiogenic shock is combined, the mortality rate is as high as 24% to 33%. The patient's cardiomyopathy progressed rapidly and recovered rapidly in the early stage. The pathogenesis may be related to the direct action of catecholamines to cause myocardial depression. The long-term increase of catecholamines in pheochromocytoma leads to downregulation of β-adrenergic receptors and the decrease in the number of myocardial contraction units. It may also lead to myocardial depression by increasing myocardial oxygen consumption, inducing coronary artery spasm of and endothelial injury, causing microcirculation dysfunction. After the concentration of circulating catecholamines decreases, inhibition is relieved and cardiac function may be restored quickly. Phochromocytoma can cause catecholamine cardiomyopathy, but for patients with initial diagnosis, myocardial damage is the main manifestation, clinical diagnosis is difficult if there is no obvious blood pressure fluctuation.When the patient's myocardial depression causes acute left heart failure and cardiogenic shock, the assistance of VA-ECMO can reduce the burden on the heart and stabilize the hemodynamics of , help restore the heart function and make the patient safe.
Department introduction
Department of critical care medicine at Dezhou Hospital, Qilu Hospital, Shandong University, currently there are 13 doctors, all of whom have full-time postgraduate education, 1 senior high school, 1 associate senior high school, 10 attending physicians, and 1 resident doctor. 25 high-quality nursing staff. Having experienced the experience of the new crown epidemic, it is a united and cohesive group that can endure hardships and fight. From severe compound injury , severe craniocerebral injury, acute severe pancreatitis, severe sepsis shock , cardiogenic shock to amniotic fluid embolization , the successful rescue experience of almost all types of severe patients has tempered the team.
Based on the team's combat, the hospital's critical care medicine department is subdivided into subspecialties. According to the strengths of each doctor, they are sent out to study in a targeted manner, so that they have their own expertise in subspecialties such as severe respiratory, severe kidney, severe heart, severe nerves, severe ultrasound, severe infection and severe nutrition, and become experts in their respective directions, and integrate into a joint force within the critical care medicine department to improve the success rate of treatment for complex and critically ill patients.
Source: Shandong University Qilu Hospital Dezhou Hospital
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