The ECMO team got united to save the girl with fulminant myocarditis

From:Children’s Hospital of Soochow University    Release time:2019-11-04

A week ago, a 9-year-old girl named Xiaodong had a fever. As usual, everyone thought it was just a common cold. As she began to vomit, her condition went into a precipitous decline. Xiaodong had a serious ventricular arrhythmia accompanied with faint, which made her parents feel completely at a loss. At that night, she was transferred to the Department of Critical Care Medicine of our hospital for rescue, where she was quickly diagnosed as fulminant myocarditis and cardiogenic shock. What’s more, she had complications such as severe acidosis, anuria, systolic weakness and low blood pressure. Xiaodong was critically ill.


At this time, only with the support of extracorporeal membrane oxygenation (ECMO) would there by hope for survival. ECMO is a life support technique that replaces human heart and lungs with artificial ones, giving life support to patients with sudden heart and lung failure and winning precious time for etiological treatment. The ECMO team consisting of the Department of Cardiothoracic Surgery, the Department of Intensive Care, and the Department of Cardiology made rapid response. At about 10 o’clock in the evening, the directors of each department gave personal instruction and successfully completed multidisciplinary consultation and discussion. In the operating room, while performing the transshipment and active rescue, the extracorporeal circulation perfusionist quickly started ECMO installation, with doctors from the Department of Cardiothoracic Surgery and the Anesthesiology Department closely cooperating to maintain the vital signs of the little girl and conduct the intubation. The whole process was carried out in a tense and orderly manner. Just four hours after admission, ECMO has already started working on the body of Xiaodong. At this point, the hands of the clock were pointing at 1 A.M. In the intensive care unit, relevant medical workers had long been waiting, because the real test just begun.

ECMO support won time for Xiaodong, but the follow-up treatment must follow up. Severe internal environmental disorders and acidosis, rapidly deteriorating liver and renal functions, and abnormal blood coagulation function must be closely monitored and carefully treated. The ECMO team conducted echocardiographic assessments every morning and at least one hour of joint round; as Xiaodong’s condition changes, multidisciplinary consultations were performed whenever possible; the doctors in the intensive care units of the internal medicine and surgical departments closely cooperated with each other, and the nursing team was also composed by the most outstanding nurses. In the next few days, Xiaodong’s condition was gradually improving. The little heart previously beating irregularly began to work regularly after 10 hours of “rest”, and the heart was able to contract powerfully on the 4th day. Besides, the other organs were slowly recovering their functions as well. After four and a half days’ support, ECMO was smoothly withdrawn. The next day, Xiaodong came to herself and began to breathe spontaneously without the help of the ventilator. She is currently in stable rehabilitation.

In the past, patients suffering from some diseases with extremely high mortality such as fulminant viral myocarditis and cardiac arrest would be announced dead if they failed to regain consciousness after the doctors had performed cardiopulmonary resuscitation for a certain period of time.

Now, the boundary between life and death is gradually being redefined by medical technology. According to relevant reports, the mortality rate of fulminant myocarditis and cardiogenic shock is extremely high, but the success rate of treatment with ECMO technology can reach as high as 70-80%. At present, the overall success rate of ECMO treatment of various cardiopulmonary failures at home and abroad is about 50%. Since the launch of ECMO, our hospital has successfully treated a number of patients with cardiac failure after heart surgery and those with respiratory failure caused by severe pneumonia, with the youngest patient being only three months old. The successful treatment of fulminant myocarditis and cardiogenic shock in this case shows that the ECMO treatment technology and team integration in our hospital are becoming increasingly mature, symbolizing a new level of critical care treatment of our hospital.

The highlight of ECMO is not the advanced nature of the equipment, but team management. In this case, it is our rapid response mechanism, catheterization performed early in the morning, daily multidisciplinary rounds, strict coagulation management and maintenance of organ function, as well as the clear division of labor and close cooperation between the surgeons, perfusionists, custodial doctors, ICU nurses etc. of our team that saved this life.

For Xiaodong, she just dreamed an endless dream; while the medical workers overcame countless overwhelming difficulties in treatment and care during that period of time so that the patient could wake up from her endless dream.