Clinical Features and Mortality of ICU Patients with Thyroid Storm Receiving Extracorporeal Membrane Oxygenation: A Single-Center Experience in Taiwan.

Background: Thyroid storm represents a critical and potentially life-threatening complication of thyrotoxicosis. Despite modern critical care, it has a high mortality rate and often requires admission to the intensive care unit (ICU) and the application of extracorporeal membrane oxygenation (ECMO). This study aimed to investigate the outcomes of thyroid storm patients requiring ECMO in a Taiwanese ICU setting. Methods: This retrospective study included patients admitted to the ICU at a medical center in Taiwan from 2018-2021 who were diagnosed with thyroid storm and required ECMO. The patients were categorized into survivor and non-survivor groups. The primary outcome evaluated was ICU mortality rate. Univariate logistic regression analysis was conducted to determine associations between study variables and ICU mortality. Results: Fourteen patients received ECMO, with a median age of 39 years, and 57.1% were male. Key triggers included non-compliance with medications and amiodarone use. The median ECMO support duration and ICU stay were 93.5 hours and 10 days, respectively. Four patients (28.6%) died, of whom three died from unsuccessful ECMO removal. An elevated lactate level on the first day of admission was significantly associated with increased mortality risk (odds ratio = 1.64, 95% confidence interval: 1.02-2.63, p = 0.04). Conclusions: The survival rate of ICU patients with thyroid storm and treated with ECMO was approximately 70%, highlighting the effectiveness of ECMO and potential benefits in critical cases. Early lactate levels on admission day 1 may serve as a prognostic tool in this specific patient subgroup.