|
|
|
|
|
| Extracorporealmembranousoxygenationforcardiogenicshockduetopediatricfulminantmyocarditis |
| GUO Yu- xiong，HE Shao- ru，SUN Yue- yu，ZHOU Cheng- bing，SHI Ji- jun，TENG yun，HU Yan，ZHANG Chao- ying，CHANG Yan- jun，LIN Xiao- yuan |
| Department of Pediatric Intensive Care Unit，Guangdong General Hospital，Guangdong Academic of Medical Science，Guangzhou 510080，China |
|
|
|
|
Abstract Objective To summarize the effectiveness of acute fulminant myocarditis patient with cardiogenic shock supported by extracorporeal membrane oxygenation（ECMO）and evaluate its safety. Methods The clinical data of a 6-year old boy suffered from acute fulminant myocarditis with refractory cardiogenic shock rescued with venoarterial ECMO（VA-ECMO）mode successfully at the department of pediatric intensive care unit of Guangdong General Hospital in August 2015 were retrospectively summarized. The pre-ECMO，post-ECMO vital signs，inotropies，vasopressors，TNT-HS and ProBNP blood levels and degrees and the ECMO-related complications were analyzed and the literature was reviewed. Results The length of ECMO support was 86 hours. Left ventricular ejection fraction（LVEF）and fractional shortening（FS）assessed by Doppler echocardiography on admission were 41% and 20%，24% and 11% at initial ECMO support，then improved to 34% and 23%，41% and 23%，49% and 27% during the 3 consecutive days of ECMO respectively，58% and 29% at the time of EC⁃MO termination. TNT-HS and ProBNP blood levels showed a downward tendency after ECMO but exhibited a short rebound in termination of ECMO，the vital signs were stable，the systolic and diastolic blood pressure were increased gradually，and the dosage of inotropics and vasoactive agents were tapered gradually until discontinued. Major complications during ECMO included the insertion site errhysis of internal jugular arteriovenous catheterization，acute hemolytic anemia，thrombocytopenia，subcutaneous hemorrhage of the right upper limb，local hematoma occurred at the insertion site of femoral vein. The patient recovered with normal cardiac function. The length of stay was 3 weeks. Conclusion ECMO is a life-saving treatment strategy and can be successfully used for children with severe fulminant myocarditis. Shortening the duration of ECMO support can reduce the potentially serious complications and ensure the safety of patient.
|
|
Received: 19 October 2015
|
|
Corresponding Authors:
HE Shao-ru，Email: hsr1065@126.com
|
|
|
|
| [1] Saji T，Matsuura H，Hasegawa K，et al. Comparison of the clinical presentation， treatment， andoutcome of fulminant and acute⁃myocarditis in children[J]. Circ J，2012，76（5）:1222-1228.
[2] Hsu KH ，Chi NH ，Yu H ，et al. Extracorporeal membranous oxygenation support for acute fulminant myocarditis:analysis of a single center's experience[J]. Eur J Cardiothorac Surg，2011，40（3）:682-688.
[3] del Nido PJ. Extracorporeal membrane oxygenation for cardiac support in children[J]. Ann Thorac Surg，1996，61（1）:336-339.
[4] Fleming GM，Gurney JG，Donohue JE，et al. Mechanical component failures in 28，171 neonatal and pediatric extracorporeal membrane oxygenation courses from 1987 to 2006[J]. Pediatr Crit Care Med，2009，10（4）:439-444.
[5] Kodama M，Oda H，Okabe M，et al. Early and long-term mortality of the clinical subtypes of myocarditis[J]. Jpn Circ J，2001，65（11）:961-964.
[6] Catena E，Paino R，Milazzo F，et al. Mechanical circulatory support for patients with fulminant myocarditis: the role of chocardiography to address diagnosis，choice of device，management，and recovery[J]. J Cardiothorac Vasc Anesth，2009，23（1）:87-94.
[7] Soongswang J，Durongpisitkul K，Nana A，et al. Cardiac troponin T:a marker inthediagnosis of acute myocarditis in children[J]. Pediatr Cardiol，2005，26（1）:45-49.
[8] Cooper LT Jr. Myocarditis[J]. N Engl J Med，2009，360:1526-1538.
[9] Al-Biltagi M，Issa M，Hagar HA，et al. Circulating cardiac troponins levels and cardiac dysfunction in children with acute and fulminant viral myocarditis[J]. Acta Paediatr，2010，99（10）:1510-1516.
[10] ChenYS，Chu SH，Ko WJ. Rescue for acute myocarditis with shock by extracorporeal membrane oxygenation[J]. Ann Thorac Surg，1999，68（6）:2220-2224.
[11] ChenYS，Yu HY，Huang SC，et al. Experience and result of extracorporeal membrane oxygenation treating fulminant myocarditis with shock: what mechanical support should be considered first[J].Heart Lung Transplant，2005，24（1）:81-87.
[12] Brogan TV，ZabrockiL，Thiagarajan RR，et al. Prolonged extracorporeal membrane oxygenation for children with respiratory failure[J]. Pediatr Crit Care Med，2012，13（4）:e 249-254.
[13] Tsuneyoshi H，Rao V. The Role of extracorporeal membrane oxygenation（ECMO）therapy in acute heart failure[J]. Int Anesthesiol Clin，2012，50（3）:114-122.
[14] Kanamaru H，Karasawa K，Abe O，et al. Recommendations for weaning off cardiopulmonary support in children with fulminantmyocarditis[J]. Circ J，2007，71（10）:1551-1554.
[15] Lin YJ，Chung SY，Liang CD，et al. Impact of extracorporeal membrane oxygenation support on clinical outcome of pediatric patients with acute cardiopulmonary failure:a single- center experience[J].Biomed J，2013，36（1）:28-34.
[16] Teele SA， Allan CK， Laussen PC，et al. Management and outcomes in pediatric patients presenting with acute fulminant myocar ⁃ditis[J]. J Pediatr，2011，158（4）:638-643.
[17] Lee EY，Lee HL，Kim HT，et al. Clinical features and short-term outcomes of pediatric acute fulminant myocarditis in a single center[J]. Korean J Pediatr，2014，57（11）:489-495.
[18] Ning B，Zhang C，Lin R，et al. Local experience with extracorporeal membrane oxygentaion in children with acute fulminant myocarditis[J]. PLoS One，2013，8（12）:e82258.
[19] Nahum E，Dagan O，Lev A，et al. Favorable outcome of pediatric fulminant myocarditis supported by extracorporeal membranous oxygenation[J]. Pediatr Cardiol，2010，31（7）:1059-1063.
[20] Mani A，Shankar S，Tan TH，et al. Extracorporeal membrane oxygenation for children with fulminant myocarditis[J]. Asian Cardiovasc Thorac Ann，2010，18（2）:131-134. |
|
|
|
Address: 1 North 2nd Street,
Zhongguancun, 
