title: Extracorporeal life support for treatment of children with enterovirus 71 infection-related cardiopulmonary failure.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Paediatrics, Taichung Veterans General Hospital, Taichung 40705, Taiwan. sljan@vghtc.gov.tw
authors.forename: Sheng-Ling
authors.initials: SL
authors.lastname: Jan
authors.forename: Shing-Jong
authors.initials: SJ
authors.lastname: Lin
authors.forename: Yun-Ching
authors.initials: YC
authors.lastname: Fu
authors.forename: Ching-Shiang
authors.initials: CS
authors.lastname: Chi
authors.forename: Chung-Chi
authors.initials: CC
authors.lastname: Wang
authors.forename: Hao-Ji
authors.initials: HJ
authors.lastname: Wei
authors.forename: Yen
authors.initials: Y
authors.lastname: Chang
authors.forename: Betau
authors.initials: B
authors.lastname: Hwang
authors.forename: Po-Yen
authors.initials: PY
authors.lastname: Chen
authors.forename: Fang-Liang
authors.initials: FL
authors.lastname: Huang
authors.forename: Ming-Chih
authors.initials: MC
authors.lastname: Lin
mesh_terms: D000293:Adolescent; D029821:Enterovirus A, Human / Q000472:pathogenicity; D004769:Enterovirus Infections / Q000150:complications*; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006323:Heart Arrest / Q000382:microbiology* / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D013624:Taiwan