Mechanical support for the treatment of fulminant myocarditis combined with cardiac arrest and MODS in children: A case report and review

A 13 years and 1 month old child was admitted to the hospital with fulminant myocarditis. After admission, the child's condition deteriorated rapidly, with a rapid drop in blood pressure, alternating malignant arrhythmias, such as ventricular tachycardia and ventricular fibrillation, and then developed rapid cardiac arrest, which lasted for 62 min. Moreover, the child developed multiple organ failure (heart, kidney, brain, lungs, liver, gastrointestinal tract, and inflammatory system) with internal environmental disturbances, indicating critical conditions. After emergency extracorporeal membrane oxygenation (ECMO) and an intra-aortic balloon pump (IABP), continuous renal replacement therapy (CRRT) was administered to dehydrate and maintain homeostasis of the internal environment. The treatment plan was adjusted in a timely manner by performing standardized and detailed comprehensive respiratory, circulatory, anti-infection, volume, anticoagulation, skin, and physical rehabilitation treatments. The patient was transferred to the ICU 15 days later. The patient was successfully discharged from the hospital and resumed normal studies and life without any neurological sequelae. This case is the first study of ECMO combined with IABP and CRRT for the treatment of fulminant myocarditis combined with cardiac arrest and multiple organ failure in children, which has not yet been reported in the literature. The duration of the cardiac arrest in this case was extremely long (62 min), and the patient had a good prognosis for the resumption of normal life and growth. This case suggests the need for early recognition of fulminant myocarditis and early initiation of devices for circulatory function support, such as ECMO and IABP. Additionally, early initiation of CRRT can assist in precise volume management, reduce cerebral edema, stabilize the internal environment, and reduce organ functional damage, which is a strong guarantee of treatment.