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Venoarterielle ECMO als „bridge to recovery“

Kardiogener Schock und Verdacht auf Myokarditis bei einer 37-Jährigen

Veno-arterial ECMO as bridge to recovery

Cardiogenic shock and suspected myocarditis in a 37-year-old patient

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Zusammenfassung

Wir berichten über eine 37-jährige Patientin im fulminanten kardiogenen Schock, mit nahezu nichtkontraktilen Ventrikeln und elektromechanischer Entkoppelung. Unter Reanimation über 90 min gelang die Implantation einer venoarteriellen extrakorporalen Membranoxygenierung (VA-ECMO), welche für 13 Tage notwendig wurde. Anschließend kam es zu einem Arrest jeglicher Herzkammeraktionen und einem ausgeprägten Multiorganversagen. Ein Schnelltest für RSV („respiratory syncytial virus“) fiel positiv aus, sodass der Verdacht auf Myokarditis bestand. Trotz zahlreicher Komplikationen stellte sich eine Restitutio ad integrum ein.

Abstract

We report a case of a 37-year-old patient presenting with fulminant cardiogenic shock, almost noncontractile ventricles, followed by electromechanical dissociation. During performance of cardiopulmonary resuscitation, a veno-arterial extracorporeal membrane oxygenation device (VA ECMO) was implanted, which became necessary for 13 days. Subsequently, a total arrest of ventricular function was observed and prominent multiple organ failure emerged. A rapid test for respiratory syncytial virus was positive, supporting the suspected diagnosis of myocarditis. Despite numerous complications, complete recovery was achieved.

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Authors and Affiliations

  1. Zentrum der Inneren Medizin, Medizinische Klinik III Kardiologie/Nephrologie/Angiologie, Klinikum der Goethe-Universität, Theodor-Stern-Kai 7, 60590, Frankfurt, Deutschland

    H. Fox, F.H. Seeger, J. Schmitt, M. Potente, S. Fichtlscherer &  J.R. Ehrlich

  2. Zentrum der Chirurgie, Klinik für Thorax-, Herz- und Thorakale Gefäßchirurgie, Klinikum der Goethe-Universität, Frankfurt, Deutschland

    O. Dzemali

Authors
  1. H. Fox
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  2. F.H. Seeger
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  3. J. Schmitt
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  4. M. Potente
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  5. O. Dzemali
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  6. S. Fichtlscherer
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  7. J.R. Ehrlich
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Corresponding author

Correspondence to J.R. Ehrlich.

Zusatzmaterial online

63_2011_64_MO1_ESM.mov

Video 1: echokardiografischer subcostaler Vierkammerblick der Patientin zum Zeitpunkt der Aufnahme auf die Intensivstation mit nahezu akontraktilen Ventrikeln (QuickTime - 0,9 MB)

63_2011_64_MO2_ESM.mov

Video 2: echokardiografischer subcostaler Vierkammerblick der Patientin zum Zeitpunkt der Erholung mit wieder gut kontraktilen Ventrikeln (QuickTime - 1,2 MB)

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Fox, H., Seeger, F., Schmitt, J. et al. Venoarterielle ECMO als „bridge to recovery“. Med Klin Intensivmed Notfmed 107, 206–212 (2012). https://doi.org/10.1007/s00063-011-0064-z

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  • DOI: https://doi.org/10.1007/s00063-011-0064-z

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