Circulatory support for prolonged electro-mechanical standstill in fulminant pediatric myocarditis.
Shriprasad R DeshpandeRenee C WillettKarthik RamakrishnanSyed Murfad PeerPranava SinhaPublished in: The International journal of artificial organs (2020)
Pediatric patients with fulminant myocarditis can rarely present with complete heart block with severe hemodynamic compromise, cardiac arrest and require circulatory support. Additionally, patients with cardiac dysfunction that require extracorporeal membrane oxygenation (ECMO) support sometimes develop cardiac stun or standstill. These factors are associated with extremely poor survival. We present a case of fulminant myocarditis presenting with dense heart block, no ventricular electrical activity resuscitated with ECMO that developed prolonged cardiac standstill. We present the clinical course, management including ECMO followed by biventricular assist devices, pacing and review supporting literature. We hope that the case will highlight challenges in management and decision making in such patients.
Keyphrases
- extracorporeal membrane oxygenation
- acute respiratory distress syndrome
- cardiac arrest
- left ventricular
- respiratory failure
- heart failure
- end stage renal disease
- cardiac resynchronization therapy
- cardiopulmonary resuscitation
- chronic kidney disease
- systematic review
- newly diagnosed
- liver failure
- mechanical ventilation
- ejection fraction
- atrial fibrillation
- prognostic factors
- peritoneal dialysis
- oxidative stress
- early onset
- young adults
- high resolution