Case report: VA-ECMO as a bridge to collapse in carcinoid heart disease.

Background: Carcinoid heart disease is a rare complication of neuroendocrine tumours caused by chronic exposure to vasoactive substances, leading to progressive valvular dysfunction and right heart failure. The use of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in this context remains controversial, as it may exacerbate carcinoid crisis by bypassing the pulmonary metabolism of these vasoactive mediators. Case summary: We describe a patient with clinical suspicion of a neuroendocrine tumour and severe carcinoid heart disease who developed refractory cardiogenic shock. VA-ECMO was initiated as rescue support but resulted in an abrupt haemodynamic collapse, the patient subsequently progressed to multiorgan failure and died. This case illustrates the paradoxical and potentially deleterious effects of extracorporeal support in the setting of carcinoid physiology. Discussion: In the setting of a carcinoid crisis with cardiogenic shock secondary to right ventricular failure, VA-ECMO may appear as a potential option for haemodynamic support. However, by reducing pulmonary blood flow-and consequently the degradation of vasoactive substances-its use may worsen the patient's clinical condition. Therefore, a multidisciplinary approach involving cardiology, acute cardiac care, intensive care, oncology, gastroenterology, endocrinology, and pathology teams is essential, both in diagnosis and management.