Table 1.
Summary of cases with use of ECMO and other extra-corporeal systems in patients with severe thyrotoxicosis or thyroid storm.
| Study | Patient gender | Patient age | Indication for ECMO | Duration of ECMO | Pre-ECMO LVEF | Post-ECMO LVEF | Other extra-corporeal system used | Biochemical response after extra-corporeal treatment | Outcome |
|---|---|---|---|---|---|---|---|---|---|
| Koh et al. (4) | Male | 44 | PEA collapse with shock | ~3 days | 20-25% | – | TPE (4 cycles), CRRT | fT4 from 57 to 22pmol/L; fT3 from 12.4 to 6.0pmol/L |
Survived. Underwent thyroidectomy. |
| Wong et al. (5) | Male | 44 | Recurrent PEA collapse | 3 days | 20% | 35% | TPE (3 days) | fT4 from 61.3 to 22.0pmol/L; fT3 from 23.5 to 4.3pmol/L |
Survived. Underwent thyroidectomy. |
| Eyadiel et al. (6) | Female | 27 | Cardiogenic shock | 6 days | <10% | Almost completely recovered* | TPE (3 cycles) | Normalization of T3* | Survived. |
| Manuel et al. (7) | Male | 26 | PEA collapse with shock | 24 hours | – | - | TPE (2 cycles) via ECMO circuit | fT4 >100pmol/L at baseline, reportedly improved on discharge* | Survived. Underwent thyroidectomy. |
| Chao et al. (19) | Male | 47 | Refractory shock | 19-115.6 hours (mean 82 hours) | 20-40% (Mean 24%) |
38-64% (mean 55%) on day 6 | – | – | Expired, from multi-organ failure |
| Male | 43 | – | Expired, from hepatic failure | ||||||
| Female | 37 | fT4 54.8-308.9pmol/L at baseline, reportedly improved on discharge* | Survived | ||||||
| Male | 42 | Survived | |||||||
| Female | 33 | Survived | |||||||
| Hsu et al. (20) | Male | 47 | Cardiogenic shock | 19 hours | 32% | – | – | – | Expired |
| Male | 43 | PEA collapse | 114 hours | 20% | 64% | fT4 31.1pmol/L at baseline; serum T3 3.64 improved to 1.69nmol/L |
Survived | ||
| Female | 37 | PEA collapse | 94 hours | 32% | 60% | fT4 96.5 improved to 19.3pmol/L | Survived | ||
| Male | 42 | Shock | 102 hours | 29% | 58% | fT4 57.9 improved to 18.3pmol/L | Survived | ||
| White et al. (21) | Female | 57 | PEA collapse | 10 days | <10% | 20-30% | – | Clinical improvement. Improvements in thyroid hormone not documented* |
Survived |
| Pong et al. (22) | Male | 33 | Cardiogenic shock | 4 days | 10% | 51% | – | fT4 55pmol/L, normalized after 1 week | Survived |
| Female | 35 | Cardiogenic shock | 4 days | 17% | 52% | – | fT4 44pmol/L, normalized after 4 days | Survived | |
| Allencheril et al. (23) | Male | 29 | PEA collapse | 7 days | <20% | 45-49% | – | Clinical improvement. Improvements in thyroid hormone not documented* |
Survived |
| Kiriyama et al. (24) | Female | 54 | Cardiogenic shock | 18 days | <20% | Almost completely recovered* | – | fT4 49.3pmol/L, fT3 7.04pmol/L at baseline, reportedly improved on discharge* | Survived |
| Kim et al. (25) | Male | 52 | Cardiogenic shock | 6 days | <20% | 40% | – | fT4 100.0pmol/L, fT3 7.04pmol/L at baseline, reportedly improved on discharge* | Survived |
| Genev et al. (26) | Female | 37 | Cardiogenic shock | 8 days | 30% | 35% | – | fT4 from 60.5 to 12.9pmol/L; fT3 from 13.6 to 2.5pmol/L |
Survived |
| Voll et al. (27) | Female | 35 | Recurrent PEA collapse with shock | 3 days | <20% | Normalized* | – | fT4 79pmol/L, fT3 47pmol/L, reportedly improved on discharge* | Survived. Underwent thyroidectomy. |
| Chao et al. (28) | Female | 35 | PEA collapse | 65 hours | 5% | 65% | – | fT4 100.8pmol/L, fT3 16.3pmol/L, reportedly improved on discharge* | Survived |
| Al-Saadi et al. (29) | Male | 29 | Cardiac arrest | 6 days | <20% | – | – | fT4 83.5pmol/L, fT3 7.04pmol/L at baseline, reportedly improved on discharge* | Survived |
| Kauth et al. (30) | Male | 53 | PEA collapse | 12 days | – | Normalized* | – | fT4 66.2pmol/L, fT3 19.2pmol/L, normalized on discharge* | Survived |
| Karahalios et al. (31) | Female | 29 | PEA collapse | 2 weeks | Biventricular failure* | Improved* | – | fT4 79.8pmol/L at baseline | Survived |
| Starobin et al. (32) | Male | 33 | Cardiogenic shock | – | 10% | Normalized* | – | – | Survived |
‘*’ denotes incomplete data from articles, while ‘-’ denotes absence of reported data.