How to do it: Plasmapheresis via venoarterial extracorporeal membrane oxygenation circuit for thyroid storm

Thyrotoxicosis-induced cardiomyopathy is a rare complication occurring in <1% of the population, which can require mechanical circulatory support (VA-ECMO) as a bridge to anti-thyroid therapies. Therapeutic plasma exchange (TPE) is an alternative treatment used to rapidly reduce thyroid hormone levels in refractory cases of thyrotoxic crisis without clinical improvement from other therapies. We describe a novel technique of facilitating plasmapheresis via a VA-ECMO circuit in a 26-year-old man with thyroid storm and subsequent circulatory collapse.