Département de Réanimation Médicale, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France; Université Pierre et Marie Curie (UPMC), Paris, France; Sorbonne Universités, UPMC Université Paris 06, INSERM, UMRS_1166-ICAN Institute of Cardiometabolism and Nutrition, Paris, France.
Département de Réanimation Médicale, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France; Université Pierre et Marie Curie (UPMC), Paris, France; Sorbonne Universités, UPMC Université Paris 06, INSERM, UMRS_1166-ICAN Institute of Cardiometabolism and Nutrition, Paris, France.
J Crit Care. 2018 Oct;47:61-64. doi: 10.1016/j.jcrc.2018.06.001. Epub 2018 Jun 9.
To describe patients with refractory cardiogenic shock related to influenza B virus myocarditis rescued by venoarterial Extracorporeal Membrane Oxygenation (VA-ECMO).
Consecutive patients hospitalized in our unit for influenza-associated myocarditis were prospectively included. We also conducted a systematic MEDLINE database literature review through the PubMed search engine, between 1946 and 2017.
We report the cases of 4 young patients with fulminant myocarditis requiring VA-ECMO for 6 [5-8] days. Influenza B virus was detected in all patients, either in nasopharyngeal sampling or bronchoalveolar lavage fluid. The 4 patients received oseltamivir. Heart function recovery allowed ECMO device removal without cardiac sequelae in all 4 patients. Systematic review retrieved 184 cases of influenza-associated myocarditis, most cases associated with H1N1 type-A infection during the 2009 pandemic. Forty eight cases of influenza myocarditis-associated cardiogenic shock requiring mechanical circulatory support including 3 cases due to influenza B virus were described. Mean duration of mechanical circulatory support was 8.5 ± 6 days and mortality rate was 33%.
Influenza myocarditis is a rare but reversible cause of cardiogenic shock amenable to VA-ECMO rescue. Early antiviral therapy and ECMO support should be considered for patients with fulminant myocarditis during an influenza epidemic.
描述由乙型流感病毒心肌炎引起的难治性心源性休克患者，通过静脉动脉体外膜肺氧合（VA-ECMO）得以挽救。
连续纳入因流感相关性心肌炎在我院住院的患者。我们还通过 PubMed 搜索引擎进行了系统的 MEDLINE 数据库文献综述，检索时间范围为 1946 年至 2017 年。
我们报告了 4 例年轻患者的病例，他们因暴发性心肌炎需要 VA-ECMO 治疗 6[5-8]天。所有患者均在鼻咽取样或支气管肺泡灌洗液中检测到乙型流感病毒。4 例患者均接受了奥司他韦治疗。所有 4 例患者的心功能恢复后均成功移除 ECMO 设备，且无心脏后遗症。系统综述共检索到 184 例流感相关性心肌炎病例，其中大多数与 2009 年大流行期间的 H1N1 型 A 感染相关。描述了 48 例流感心肌炎相关性心源性休克需要机械循环支持的病例，其中 3 例是由乙型流感病毒引起的。机械循环支持的平均持续时间为 8.5±6 天，死亡率为 33%。
流感心肌炎是一种罕见但可逆转的心源性休克病因，可通过 VA-ECMO 挽救。在流感流行期间，对于暴发性心肌炎患者，应考虑早期抗病毒治疗和 ECMO 支持。
