51: Rescue Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) in Hungry Bone Syndrome Post‑Parathyroidectomy

Introduction: Hungry Bone Syndrome is a relatively uncommon but profound complication of parathyroidectomy, characterized by acute severe postoperative hypocalcemia. This can precipitate cardiomyopathy due to calcium-related myocardial dysfunction. We report a case of refractory cardiogenic shock secondary to post-parathyroidectomy hypocalcemic cardiomyopathy managed successfully with veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Case Description: A 40-year-old female with severe primary hyperparathyroidism underwent left hemithyroidectomy with parathyroidectomy. Forty-eight hours postoperatively, she developed profound hypotension and hypoxemia, progressing rapidly to refractory cardiogenic shock. Laboratory evaluation revealed severe hypocalcemia (corrected calcium 0.6 mmol/L) and hypomagnesemia, without significant ST-T changes or troponin elevation; serum cortisol was 42 µg/dL. Transthoracic echocardiography demonstrated left ventricular ejection fraction (LVEF) of 15% with apical ballooning. Despite maximal inotropic support, shock persisted, prompting initiation of VA-ECMO. VA-ECMO provided immediate circulatory support, enabling aggressive intravenous calcium gluconate replacement. The patient remained on VA-ECMO for 5 days. Repeat echocardiography on day 7 showed LVEF recovery to 46%, allowing successful ECMO weaning. She was discharged neurologically intact after 41 days of hospitalization, with full recovery of cardiac function. Conclusion: This case highlights the rare but critical association between surgical stress, acute electrolyte derangements post-parathyroidectomy, and hypocalcemic cardiomyopathy leading to cardiogenic shock. In patients with refractory cardiogenic shock, VA-ECMO provides effective mechanical circulatory support, serving as a bridge to recovery. Given the highly reversible nature of stress- and hypocalcemia-induced cardiomyopathy, early initiation of VA-ECMO is warranted to ensure myocardial rest and complete functional restoration.