Use of extracorporeal membrane oxygenation for mechanical circulatory support in a patient with 5-fluorouracil induced acute heart failure.

Abstract

Extracorporeal life support has evolved to become a viable support option in patients with acute cardiac failure. Tailored mechanical circulatory support (MCS) can now be provided to patients using existing extracorporeal life support devices.1 We report the successful use of peripheral venoarterial extracorporeal membrane oxygenation (ECMO) to provide MCS to a patient with acute 5-flurouracil (5-FU)–induced cardiomyopathy. 5-FU is a key component of adjuvant chemotherapy for colorectal cancer. It is also frequently used in the treatment of gastric, esophageal, pancreatic, breast, bladder, and prostate cancer. There is a wide range of cardiotoxicity with this 5-FU, including ischemia, vasospasm, arrhythmia, hypertension, Q-T interval prolongation, and acute cardiomyopathy and 5-FU–induced cardiac complications are not rare.2 This case illustrates the crucial place of ECMO as a bridge to recovery in chemotherapy, cardiomyopathy, or decision making. A 32-year-old man began adjuvant treatment for colorectal adenocarcinoma with 5-FU continuous infusion after presumed curative bowel resection. He experienced stuttering chest pain from day 1 of therapy with progressive shortness of breath. His risk factors for cardiovascular disease included a positive family history of ischemic heart disease and previous methamphetamine use. He presented to the emergency department in a peripheral hospital on completion of his first cycle, where he was noted to be in paroxysmal atrial fibrillation with rapid ventricular response alternating with sinus tachycardia with inferolateral ST elevation. Cardiac troponin was mildly elevated and a presumptive diagnosis of 5-FU–induced cardiotoxicity was …