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Extracorporeal life support for treatment of children with enterovirus 71 infection-related cardiopulmonary failure

Sheng-Ling Jan| Shing-Jong Lin| Yun-Ching Fu| Ching-Shiang Chi| Chung-Chi Wang| Hao-Ji Wei| Yen Chang| Betau Hwang| Po-Yen Chen| Fang-Liang Huang| Ming-Chih Lin
Pediatric Original
Volume 36, Issue 3 / March , 2010

Pages 520 - 527

Abstract

Purpose

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).

Methods

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.

Results

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.

Conclusions

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.

Keywords

References

  1. Ho M, Chen ER, Hsu KH, Twu SJ, Chen KT, Tsai SF, Wang JR, Shih SR (1999) An epidemic of enterovirus 71 infection in Taiwan. Taiwan Enterovirus Epidemic Working Group. N Engl J Med 341:929–935
    • View reference on publisher's website
    • View reference on PubMed
  2. Huang CC, Liu CC, Chang YC, Chen CY, Wang ST, Yeh TF (1999) Neurologic complications in children with enterovirus 71 infection. N Engl J Med 341:936–942
    • View reference on publisher's website
    • View reference on PubMed
  3. Chang LY, Lin TY, Hsu KH, Huang YC, Lin KL, Hsueh C, Shih SR, Ning HC, Hwang MS, Wang HS, Lee CY (1999) Clinical features and risk factors of pulmonary oedema after enterovirus-71-related hand, foot, and mouth disease. Lancet 354:1682–1686
    • View reference on publisher's website
    • View reference on PubMed
  4. Jan SL, Chi CS, Hwang B, Fu YC, Chen PY, Mak SC (2000) Cardiac manifestations of fatal enterovirus infection during the 1998 outbreak in Taiwan. Chin Med J 63:612–618
  5. Fu YC, Chi CS, Chiu YT, Hsu SL, Hwang B, Jan SL, Chen PY, Huang FL, Chang Y (2004) Cardiac complications of enterovirus rhombencephalitis. Arch Dis Child 89:368–373
    • View reference on publisher's website
    • View reference on PubMed
  6. Chan LG, Parashar UD, Lye MS, Ong FG, Zaki SR, Alexander JP, Ho KK, Han LL, Pallansch MA, Suleiman AB, Jegathesan M, Anderson LJ (2000) Deaths of children during an outbreak of hand, foot, and mouth disease in Sarawak, Malaysia: clinical and pathological characteristics of the disease. For the Outbreak Study Group. Clin Infect Dis 31:678–683
    • View reference on publisher's website
    • View reference on PubMed
  7. Hsia SH, Wu CT, Chang JJ, Lin TY, Chung HT, Lin KL, Hwang MS, Chou ML, Chang LY (2005) Predictors of unfavorable outcomes in enterovirus 71-related cardiopulmonary failure in children. Pediatr Infect Dis J 24:331–334
    • View reference on publisher's website
    • View reference on PubMed
  8. Lin TY, Chang LY, Hsia SH, Huang YC, Chiu CH, Hsueh C, Shih SR, Liu CC, Wu MH (2002) The 1998 enterovirus 71 outbreak in Taiwan: pathogenesis and management. Clin Infect Dis 34(Suppl 2):S52–S57
    • View reference on publisher's website
    • View reference on PubMed
  9. Chang LY, Hsia SH, Wu CT, Huang YC, Lin KL, Fang TY, Lin TY (2004) Outcome of enterovirus 71 infections with or without stage-based management: 1998 to 2002. Pediatr Infect Dis J 23:327–332
    • View reference on publisher's website
    • View reference on PubMed
  10. Wang JN, Yao CT, Yeh CN, Huang CC, Wang SM, Liu CC, Wu JM (2006) Critical management in patients with severe enterovirus 71 infection. Pediatr Int 48:250–256
    • View reference on publisher's website
    • View reference on PubMed
  11. Chen SC, Chang HL, Yan TR, Cheng YT, Chen KT (2007) An eight-year study of epidemiologic features of enterovirus 71 infection in Taiwan. Am J Trop Med Hyg 77:188–191
    • View reference on PubMed
  12. Fu YC, Chi CS, Jan SL, Wang TM, Chen PY, Chang Y, Chou G, Lin CC, Hwang B, Hsu SL (2003) Pulmonary edema of enterovirus 71 encephalomyelitis is associated with left ventricular failure: implications for treatment. Pediatr Pulmonol 35:263–268
    • View reference on publisher's website
    • View reference on PubMed
  13. Huang YF, Chiu PC, Chen CC, Chen YY, Hsieh KS, Liu YC, Lai PH, Chang HW (2003) Cardiac troponin I: a reliable marker and early myocardial involvement with meningoencephalitis after fatal enterovirus-71 infection. J Infect 46:238–243
    • View reference on publisher's website
    • View reference on PubMed
  14. Marx M, Salzer-Muhar U, Wimmer M (1999) Extracorporeal life support in pediatric patients with heart failure. Artif Organs 23:1001–1005
    • View reference on publisher's website
    • View reference on PubMed
  15. Lequier L (2004) Extracorporeal life support in pediatric and neonatal critical care: a review. J Intensive Care Med 19:243–258
    • View reference on publisher's website
    • View reference on PubMed
  16. Chang AC, McKenzie ED (2005) Mechanical cardiopulmonary support in children and young adults: extracorporeal membrane oxygenation, ventricular assist devices, and long-term support devices. Pediatr Cardiol 26:2–28
    • View reference on publisher's website
    • View reference on PubMed
  17. Huang FL, Jan SL, Chen PY, Chi CS, Wang TM, Fu YC, Tsai CR, Chang Y (2002) Left ventricular dysfunction in children with fulminant enterovirus 71 infection: an evaluation of the clinical course. Clin Infect Dis 34:1020–1024
    • View reference on publisher's website
    • View reference on PubMed
  18. Matsubayashi T, Miwa Y, Takeda S, Koide M, Enoki H, Mizukami A, Matsubayashi R (2006) Percutaneous cardiopulmonary support in a child with enterovirus 71 encephalitis. Pediatr Int 48:327–329
    • View reference on publisher's website
    • View reference on PubMed
  19. Fiser DH, Long N, Roberson PK, Hefley G, Zolten K, Brodie-Fowler M (2000) Relationship of pediatric overall performance category and pediatric cerebral performance category scores at pediatric intensive care unit discharge with outcome measures collected at hospital discharge and 1- and 6-month follow-up assessments. Crit Care Med 28:2616–2620
    • View reference on publisher's website
    • View reference on PubMed
  20. Huang MC, Wang SM, Hsu YW, Lin HC, Chi CY, Liu CC (2006) Long-term cognitive and motor deficits after enterovirus 71 brainstem encephalitis in children. Pediatrics 118:e1785–e1788
    • View reference on publisher's website
    • View reference on PubMed
  21. Chang LY, Huang LM, Gau SS, Wu YY, Hsia SH, Fan TY, Lin KL, Huang YC, Lu CY, Lin TY (2007) Neurodevelopment and cognition in children after enterovirus 71 infection. N Engl J Med 356:1226–1234
    • View reference on publisher's website
    • View reference on PubMed
  22. Banki NM, Kopelnik A, Dae MW, Miss J, Tung P, Lawton MT, Drew BJ, Foster E, Smith W, Parmley WW, Zaroff JG (2005) Acute neurocardiogenic injury after subarachnoid hemorrhage. Circulation 112:3314–3319
    • View reference on publisher's website
    • View reference on PubMed
  23. Arab D, Yahia AM, Qureshi AI (2003) Cardiovascular manifestations of acute intracranial lesions: pathophysiology, manifestations, and treatment. J Intensive Care Med 18:119–129
    • View reference on publisher's website
    • View reference on PubMed
  24. Duncan BW, Bohn DJ, Atz AM, French JW, Laussen PC, Wessel DL (2001) Mechanical circulatory support for the treatment of children with acute fulminant myocarditis. J Thorac Cardiovasc Surg 122:440–448
    • View reference on publisher's website
    • View reference on PubMed
  25. Wu ET, Huang SC, Chen YS, Wang JK, Wu MH, Ko WJ (2006) Children with fulminant myocarditis rescued with extracorporeal membrane oxygenation. Heart 92:1325–1326
    • View reference on publisher's website
    • View reference on PubMed
  26. Murry DL (1996) Neonatal enterovirus infection: neutralization by intravenous immune globulin. Clin Infect Dis 22:397–398
    • View reference on PubMed
  27. Galama JM, Vogels MT, Jansen GH, Gielen M, Heessen FW (1997) Antibodies against enteroviruses in intravenous Ig preparations: great variation in titres and poor correlation with the incidence of circulating serotypes. J Med Virol 53:273–276
    • View reference on publisher's website
    • View reference on PubMed
  28. Svedmyr N (1990) Action of corticosteroids on beta-adrenergic receptors. Clinical aspects. Am Rev Respir Dis 141:S31–S38
    • View reference on PubMed

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