ECMO-Assisted Da Vinci Robotic Surgery for Pheochromocytoma-Induced Acute Catecholamine Cardiomyopathy: A Case Report

Abstract

Pheochromocytoma, an uncommon neuroendocrine neoplasm, has the potential to precipitate acute catecholamine cardiomyopathy (ACIC), a perilous condition characterized by cardiogenic shock and the failure of multiple organ systems. The significance of early diagnosis and the implementation of a multidisciplinary approach are paramount for patient survival. A 40-year-old female patient presented with a 6-day history of an adrenal mass, labile hypertension range of 180–120/80–90 mmHg, hyperglycemia at 19 mmol/L, and respiratory distress that progressed to cardiogenic shock with a left ventricular ejection fraction (LVEF) of 18%. Imaging studies unveiled a right adrenal mass; biochemical analyses substantiated elevated levels of plasma metanephrines. The employment of venoarterial extracorporeal membrane oxygenation (ECMO) served to stabilize hemodynamic parameters, whereas continuous renal replacement therapy (CRRT) was instrumental in managing the multiorgan dysfunction. Preoperative α-blockade with phenoxybenzamine was administered to alleviate catecholamine toxicity. The definitive therapeutic intervention comprised a da Vinci robot-assisted adrenalectomy conducted with the support of ECMO. Following the surgical procedure, the patient's vital signs reverted to normal, and the LVEF improved to 55% at the 6-month follow-up. The patient was able to resume her daily activities without any residual functional impairment. This case underscores the efficacy of the synergistic application of ECMO with robotic surgery in the management of pheochromocytoma-induced ACIC. This approach accentuates the importance of rapid diagnostic procedures, mechanical support systems, and minimally invasive surgical techniques in critical care scenarios. Further research is warranted to establish standardized protocols for such combined therapeutic interventions.