TB is one of the common infectious diseases in our country, among which lung tuberculosis is the most common, but TB bacteria can also invade many organs throughout the body, including the brain, spine, adrenal glands, and the pericardium, resulting in extrapulmonary TB. TB rarely causes acute and critical illness, and usually has a chronic onset. Unlike for this case, it is not common for TB patients to present to the ED with sudden cardiac arrest. Adrenal TB is one of the main causes of chronic adrenal insufficiency. The patient in this case had no typical clinical symptoms of TB, so early diagnosis and treatment were difficult. Therefore, patients with no typical TB symptoms should also be sufficiently cared for, and actively screened, and physicians should expand the scope of examination to avoid the emergence of severe conditions.
It is well known that a common cause of cardiac arrest is hyperkalemia, itself have many causes. Primary adrenal insufficiency can cause a decrease in the secretion of aldosterone, which is a type of hormone that can simultaneously increase blood sodium levels and reduce blood potassium levels. Therefore, when the level of aldosterone is insufficient, it can cause refractory hyponatremia and hyperkalemia. Chronic adrenal insufficiency often has an insidious onset, mainly manifested by long-term poor appetite, nausea and vomiting, and fatigue. These atypical symptoms make early diagnosis difficult. The patient did not have a systematic examination in time after he developed the symptoms, which eventually led to the deterioration of his condition.
ECMO is a new form of a mechanical cardiopulmonary life-support system. It involves the use of an artificial pump to transport nonoxygenated blood to a gas exchange device (oxygenator), where the blood is fully oxygenated and carbon dioxide is removed, after which the blood is reinfused back into the patient’s circulation. ECMO can partially assist the patient's cardiopulmonary function.
Current research indicates that the application of VA-ECMO in the ED results in good outcomes for patients with cardiac arrest requiring prolonged CPR to recover spontaneous circulation and treat refractory cardiogenic shock. ECMO plays a role as a bridge, helping provide more opportunities for the diagnosis and treatment of critically ill patients with heart and lung failure. When stable hemodynamics and adequate tissue oxygen supply are ensured for the patient, physicians have more time to actively search for the cause and treat the original disease.
Therefore, ECMO can be applied in the ED to patients with cardiac arrest of different etiologies, such as acute poisoning, internal environment disturbance, and severe infection, and for patients for whom conventional CPR has difficulty stabilizing their hemodynamics. The effects of ECMO are optimal for patients between 18–75 years old without any irreversible end-stage conditions. Patients with reversible neurological function should be given priority to receive ECMO.
However, there is still much work to be done regarding the use of ECMO in the ED. High-quality prospective randomized controlled studies are needed to further evaluate the benefits and drawbacks of this procedure. More evidence-based information is needed to formulate normative guidelines. Finally, an emergency ECMO team must be established for day and night services and continuous training should be carried out for ECMO team members.