Department of Paediatrics, Taichung Veterans General Hospital, Taichung 40705, Taiwan.
Intensive Care Med. 2010 Mar;36(3):520-7. doi: 10.1007/s00134-009-1739-2. Epub 2009 Dec 24.
Enterovirus 71 (EV71) infection leading to cardiopulmonary failure (CPF) is rare, but usually fatal. In such cases, intensive cardiorespiratory support is essential for survival. In this study, we report our experience in the treatment of EV71-related CPF with extracorporeal life support (ECLS).
This was a retrospective study of a total of 13 children, aged 16 +/- 10 months, with EV71-related hemodynamically unstable CPF, which was refractory to conventional treatments, who were rescued by transsternal ECLS from 2000 to 2008. The clinical manifestations and outcomes of the 13 children (present cohort) were compared with those of 10 children (past cohort) who had EV71-related CPF without ECLS between 1998 and 2000.
Among these 13 patients, 10 were successfully weaned off ECLS and survived. The myocardial recovery time was 71 +/- 28 (median, 69) h, and the ECLS duration was 93 +/- 33 (median, 93) h. Six surviving patients had a good neurological outcome at hospital discharge. All surviving patients had some neurological sequelae but showed improvement at follow-up, including dysphagia in nine, central hypoventilation in seven, limb weakness in six and seizure in three. The present cohort had better neurological outcomes (46 vs. 0%, P = 0.005) and a higher survival rate (77 vs. 30%, P = 0.024) than the past cohort, respectively.
Patients with EV71-related CPF supported by ECLS had a higher survival rate and fewer neurological sequelae than those who only received conventional treatments. ECLS is an effective alternative method for treatment of children with refractory EV71-related CPF.
肠道病毒 71 型（EV71）感染导致心肺衰竭（CPF）较为罕见，但通常是致命的。在这种情况下，强化心肺支持对生存至关重要。本研究报告了我们应用体外生命支持（ECLS）治疗 EV71 相关 CPF 的经验。
这是一项回顾性研究，共纳入 13 例年龄 16±10 个月的 EV71 相关血流动力学不稳定 CPF 患儿，这些患儿对常规治疗无反应，在 2000 年至 2008 年间通过胸骨切开术接受 ECLS 治疗。将这 13 例患儿（本研究组）的临床表现和结局与 1998 年至 2000 年间未接受 ECLS 的 10 例 EV71 相关 CPF 患儿（既往组）进行比较。
这 13 例患者中，10 例成功撤离 ECLS 并存活。心肌恢复时间为 71±28（中位数，69）h，ECLS 持续时间为 93±33（中位数，93）h。6 例存活患者出院时神经功能良好。所有存活患者均有一定的神经后遗症，但在随访中有所改善，包括 9 例吞咽困难、7 例中枢性低通气、6 例肢体无力和 3 例癫痫。本研究组的神经预后（46% vs. 0%，P=0.005）和存活率（77% vs. 30%，P=0.024）均优于既往组。
接受 ECLS 支持的 EV71 相关 CPF 患儿的存活率和神经后遗症发生率均优于仅接受常规治疗的患儿。ECLS 是治疗难治性 EV71 相关 CPF 的有效替代方法。
