Case Report: ECMO rescue for cardiac arrest in a hyperthyroid patient triggered by COVID-19 infection

TL;DR

A hyperthyroid patient with a severe reaction to COVID-19 nearly died from cardiac arrest but was saved using a combination of ECMO and kidney support.

Contribution

This case report highlights the successful use of VA-ECMO and CRRT in treating a rare and critical combination of hyperthyroidism, COVID-19, and fulminant myocarditis.

Findings

VA-ECMO combined with CRRT stabilized a patient with cardiac arrest due to fulminant myocarditis and thyroid storm.

Hyperthyroid patients with severe COVID-19 are at high risk for life-threatening complications like thyroid storm and myocarditis.

Timely pharmacological and supportive interventions improved survival in this critical case.

Abstract

Coronavirus disease 2019 (COVID-19) is a global pandemic, while both fulminant myocarditis (FM) and thyroid storm (TS) are life-threatening critical conditions. When these three conditions coexist in a single patient, the survival outcome can be severely compromised.

We report a case of cardiac arrest in a hyperthyroid patient triggered by COVID-19 infection. The patient developed symptoms such as fatigue, chest tightness, and chest pain following SARS-CoV-2 infection, and experienced respiratory and CA en route to the hospital. Ultimately, the patient was diagnosed with FM and TS. The patient was treated with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) combined with continuous renal replacement therapy (CRRT). After hemodynamic stabilization, the patient received pharmacological management for arrhythmia control and hyperthyroidism, along with other symptomatic treatments. The patient eventually recovered and was discharged.

In hyperthyroid patients infected with SARS-CoV-2, clinicians should remain vigilant for the potential development of FM and TS. VA-ECMO combined with CRRT represents an effective therapeutic approach in such critical scenarios.

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