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Extracorporeal membrane oxygenation for neonatal collapse caused by enterovirus myocarditis
  1. Gerard Cortina1,2,
  2. Derek Best1,
  3. Markus Deisenberg3,
  4. Roberto Chiletti1,
  5. Warwick Butt1,4
  1. 1Paediatric Intensive Care Unit, The Royal Children’s Hospital Melbourne, Melbourne, Victoria, Australia
  2. 2Department of Paediatrics, Medical University of Innsbruck, Innsbruck, Austria
  3. 3Department of Intensive Care and Neonatology, University Children’s Hospital Zurich, Zurich, Switzerland
  4. 4Department of Paediatrics, University of Melbourne, Melbourne, Australia
  1. Correspondence to Dr Gerard Cortina, Department of Paediatrics, Medical University of Innsbruck, Anichstrasse 35, Innsbruck, A-6020, Austria; gerard.cortina{at}i-med.ac.at

Abstract

Objective To describe the effect of extracorporeal membrane oxygenation (ECMO) on survival and cardiac outcome of neonates with myocardial failure secondary to severe enterovirus (EV) myocarditis.

Design Retrospective case series.

Setting A 15-bed cardiac paediatric intensive care unit (ICU).

Patients We describe the clinical presentations, cardiac findings, ECMO characteristics and outcome of seven neonates with severe EV myocarditis. Additionally, 35 previously reported cases of EV myocarditis supported with ECMO are presented.

Interventions Extracorporeal membrane oxygenation.

Results Seven neonates presented with cardiovascular collapse within the first 10 days after birth and required ECMO support. Echocardiography showed left ventricular dysfunction in all and additional right ventricular dysfunction in four patients. ECG showing widespread ST changes as well as elevated troponin I indicated myocardial damage. All patients were cannulated onto ECMO shortly after ICU admission. None of the patients suffered cardiac arrest prior to ECMO initiation. Four patients survived ECMO and three survived to hospital discharge. All three survivors showed complete cardiac recovery after a median follow-up of 34 months. The survival rate in 35 previously reported cases was 34% (12/35) and including our seven cases 36% (15/42).

Conclusions In this case series, ECMO initiation prevented further deterioration and cardiac arrest in neonates with severe EV myocarditis and not responding to conventional medical therapies. Moreover, complete cardiac recovery occurred in survivors. However, these neonates may need long ECMO runs and are at increased risk for mechanical complications. Furthermore, mortality remains high due to greater disease severity.

  • cardiogenic shock
  • extracorporeal membrane oxygenation
  • enterovirus myocarditis
  • neonatal collapse newborn

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Footnotes

  • Contributors GC and WB conceived the study. GC, DB and MD collected and analysed the data. GC prepared the first draft of the paper. This and all subsequent drafts were reviewed and revised by all authors. All authors approved the final version submitted.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not3for3profit sectors.

  • Competing interests None declared.

  • Patient consent Parental/guardian consent obtained.

  • Ethics approval Royal Children’s Hospital Human Research Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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