Extracorporeal life support for treatment of children with enterovirus 71 infection-related cardiopulmonary failure.
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.
Jan
Sheng-Ling
SL
Department of Paediatrics, Taichung Veterans General Hospital, Taichung 40705, Taiwan. sljan@vghtc.gov.tw
Lin
Shing-Jong
SJ
Fu
Yun-Ching
YC
Chi
Ching-Shiang
CS
Wang
Chung-Chi
CC
Wei
Hao-Ji
HJ
Chang
Yen
Y
Hwang
Betau
B
Chen
Po-Yen
PY
Huang
Fang-Liang
FL
Lin
Ming-Chih
MC
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