Singapore Med J 2014; 55(3): e37-e38; http://dx.doi.org/10.11622/smedj.2014040
Extracorporeal life support for cardiac arrest in a paediatric emergency department
Chew SP, Tham LP
Correspondence: Dr Tham Lai Peng Sharon, tham.lai.peng@kkh.com.sg
ABSTRACT
The initiation of extracorporeal membrane oxygenation (ECMO) in the emergency department (ED) is a rare event. Herein, we report a case of acute fulminant myocarditis in a nine-year-old girl who was successfully resuscitated by early initiation of ECMO support in the paediatric ED of KK Women’s and Children’s Hospital, Singapore. The patient had rapidly progressed into a witnessed pulseless ventricular tachycardia on presentation, and ECMO was started in the ED following the failure of standard resuscitation measures to establish spontaneous circulation. ECMO was continued for nine days. The patient recovered well with normal neurocognitive function. The initiation of ECMO in the ED is potentially life-saving in the resuscitation of children with witnessed in-hospital cardiac arrest due to a reversible cause.
Keywords: emergency department, extracorporeal membrane oxygenation, fulminant myocarditis
Singapore Med J 2014; 55(3): e37–e38; http://dx.doi.org/10.11622/smedj.2014040
REFERENCES
1. Yamamoto LG, Young LL. Acute-onset dysrhythmia heralding fulminant myocarditis and refractory cardiac arrest treated with ED cardiopulmonary bypass and extracorporeal membrane oxygenation. Am J Emerg Med 2007; 25:348-52.
http://dx.doi.org/10.1016/j.ajem.2006.05.028 |
| |
| 2. National Resuscitation Council. Singapore National Resuscitation Guidelines 2011 [online]. Available at: www.nrcsingapore.org/sg/conference2011/ppt/AdvancedCardiacLifeSupportGui.... Accessed September 13, 2013. |
| |
3. Kane DA, Thiagarajan RR, Wypij D, et al. Rapid-response extracorporeal membrane oxygenation to support cardiopulmonary resuscitation in children with cardiac disease. Circulation 2010; 122(Suppl 11):S241-8.
http://dx.doi.org/10.1161/CIRCULATIONAHA.109.928390 |
| |
4. Posner JC, Osterhoudt CK, Mollen CJ, et al. Extracorporeal membrane oxygenation as a resuscitative measure in the pediatric emergency department. Pediatr Emerg Care 2000; 16:413-5.
http://dx.doi.org/10.1097/00006565-200012000-00008 |
| |
5. Huang SC, Wu ET, Chen YH, et al. Extracorporeal membrane oxygenation rescue for cardiopulmonary resuscitation in pediatric patients. Crit Care Med 2008; 36:1607-13.
http://dx.doi.org/10.1097/CCM.0b013e318170b82b |
| |
| 6. Alsoufi B, Al-Radi OO, Nazer RL, et al. Survival outcomes after rescue extracorporeal cardiopulmonary resuscitation in pediatric patients with refractory cardiac arrest. J Thorac Cardiovasc Surg 2007; 134: 952-959.e2. |
| |
7. Morris MC, Wernosky G, Nadkarni VM. Survival outcomes after extracorporeal cardiopulmonary resuscitation instituted during active chest compression following refractory in-hospital pediatric cardiac arrest. Pediatr Crit Care Med 2004; 5:440-6.
http://dx.doi.org/10.1097/01.PCC.0000137356.58150.2E |
| |
8. Kelly RB, Porter PA, Meier AH, Myers JL, Thomas NJ. Duration of cardiopulmonary resuscitation before extracorporeal rescue: how long is not long enough? ASAIO J 2005; 51:665-7.
http://dx.doi.org/10.1097/01.mat.0000171596.39362.7a |
| |
9. Mani A, Shankar S, Tan TH, Wong KY. Extracorporeal membrane oxygenation for children with fulminant myocarditis. Asian Cardiovasc Thorac Ann 2010; 18:131-4.
http://dx.doi.org/10.1177/0218492309361162 |
