A case of pediatric out-of-hospital cardiac arrest due to fulminant myocarditis requiring extracorporeal cardiopulmonary resuscitation
1Department of Emergency and Critical Care Medicine, Nara Medical University, 634-8522 Nara, Japan
2Department of Emergency and Critical Care Medicine, Nara Prefecture General Medical Center, 630-8581 Nara, Japan
3Department of Thoracic and Cardiovascular Surgery, Nara Medical University, 634-8522 Nara, Japan
4Department of Pediatrics, Nara Medical University, 634-8522 Nara, Japan
Submitted: 18 April 2023 Accepted: 02 June 2023
Online publish date: 07 August 2023
A 7-year-old girl presented with a 2-day history of fever and chest pain that led her to collapse, prompting her father to call the emergency medical services (EMS). Both an EMS ambulance and a physician-staffed ambulance were dispatched to the scene. Upon arrival, the EMS crew discovered that the patient was in cardiac arrest, with ventricular fibrillation (VF) as the initial heart rhythm. Due to the patient’s refractory VF, the physician requested the receiving hospital to prepare for extracorporeal cardiopulmonary resuscitation (ECPR), which was successfully initiated 105 minutes after the patient’s collapse. The patient was admitted to the intensive care unit, where her cardiac function gradually improved. On the eighth day, she was successfully weaned off extracorporeal membrane oxygenation and discharged from the hospital on the thirty-third day without any neurological complications. The presumed cause of the cardiac arrest was fulminant myocarditis, based on the patient’s clinical history and findings from cardiac magnetic resonance imaging. Overall, early mechanical cardiopulmonary support is crucial for patients with fulminant myocarditis. However, cases resulting in out-of-hospital cardiac arrest generally have poor outcomes, even with ECPR. This particular case demonstrated that optimal resuscitation, spanning from the prehospital phase to the intensive care unit, utilizing ECPR, played a vital role in achieving a favorable neurological outcome.
Cardiac arrest; Extracorporeal membrane oxygenation; Myocarditis; Pediatric; Prehospital care
Kimiko Murakami,Keisuke Takano,Arisa Kinoshita,Shun Hiraga,Kazuhiro Mitani,Shinya Yokoyama,Nobuyuki Tsujii,Takahiro Kajimoto,Aya Sasaki,Hidetada Fukushima. A case of pediatric out-of-hospital cardiac arrest due to fulminant myocarditis requiring extracorporeal cardiopulmonary resuscitation. Signa Vitae. 2023.doi:10.22514/sv.2023.075.
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