Wang Xuan, Zou Guangmei
Department of Cardiac Surgical Intensive Care Unit, Yantai Yuhuangding Hosptial, Qingdao University Affiliated Hospital, No. 20 of Yuhuangding East Road, Yantai, Shandong, 264000, China.
Heliyon. 2024 Aug 22;10(17):e36723. doi: 10.1016/j.heliyon.2024.e36723. eCollection 2024 Sep 15.
A 13 years and 1 month old child was admitted to the hospital with fulminant myocarditis. After admission, the child's condition deteriorated rapidly, with a rapid drop in blood pressure, alternating malignant arrhythmias, such as ventricular tachycardia and ventricular fibrillation, and then developed rapid cardiac arrest, which lasted for 62 min. Moreover, the child developed multiple organ failure (heart, kidney, brain, lungs, liver, gastrointestinal tract, and inflammatory system) with internal environmental disturbances, indicating critical conditions. After emergency extracorporeal membrane oxygenation (ECMO) and an intra-aortic balloon pump (IABP), continuous renal replacement therapy (CRRT) was administered to dehydrate and maintain homeostasis of the internal environment. The treatment plan was adjusted in a timely manner by performing standardized and detailed comprehensive respiratory, circulatory, anti-infection, volume, anticoagulation, skin, and physical rehabilitation treatments. The patient was transferred to the ICU 15 days later. The patient was successfully discharged from the hospital and resumed normal studies and life without any neurological sequelae. This case is the first study of ECMO combined with IABP and CRRT for the treatment of fulminant myocarditis combined with cardiac arrest and multiple organ failure in children, which has not yet been reported in the literature. The duration of the cardiac arrest in this case was extremely long (62 min), and the patient had a good prognosis for the resumption of normal life and growth. This case suggests the need for early recognition of fulminant myocarditis and early initiation of devices for circulatory function support, such as ECMO and IABP. Additionally, early initiation of CRRT can assist in precise volume management, reduce cerebral edema, stabilize the internal environment, and reduce organ functional damage, which is a strong guarantee of treatment.
一名13岁1个月大的儿童因暴发性心肌炎入院。入院后，患儿病情迅速恶化，血压急剧下降，交替出现恶性心律失常，如室性心动过速和心室颤动，随后迅速发生心脏骤停，持续了62分钟。此外，患儿出现多器官功能衰竭（心脏、肾脏、脑、肺、肝脏、胃肠道和炎症系统）并伴有内环境紊乱，情况危急。在进行紧急体外膜肺氧合（ECMO）和主动脉内球囊反搏（IABP）后，给予持续肾脏替代治疗（CRRT）以脱水并维持内环境稳态。通过进行标准化、详细的综合呼吸、循环、抗感染、容量、抗凝、皮肤和物理康复治疗，及时调整治疗方案。15天后患者被转入重症监护病房（ICU）。患者成功出院，恢复正常学习和生活，无任何神经后遗症。本病例是ECMO联合IABP和CRRT治疗儿童暴发性心肌炎合并心脏骤停及多器官功能衰竭的首例研究，文献中尚未见报道。该病例心脏骤停持续时间极长（62分钟），患者恢复正常生活和生长的预后良好。本病例提示需要早期识别暴发性心肌炎，并尽早启动循环功能支持设备，如ECMO和IABP。此外，尽早启动CRRT有助于精确的容量管理，减轻脑水肿，稳定内环境，减少器官功能损害，是治疗的有力保障。
