Background: Ever since the spring 1998, the severe enterovirus 71 (EV71) infection in Taiwan has resulted in fatality of 240 children, mostly under 3-years-old. Aside from hand-foot-mouth syndrome or herpangina, a full-blown severe EV71 infection tends to invade the brain stem and presents itself by 3 devastating stages as encephalomyelitis, hypercatecholamine and cardiogenic shock. Case fatality rates in those patients complicated with cardiogenic shock and/or pulmonary hemorrhage are as high as 80%.

Design/Objective: Use ECMO to rescue patients of severe EV71 infection complicated with cardiogenic shock.

Methods: There were 5 cases of severe EV71 infection who received urgent ECMO therapy during Aug. 2004 through July 2008 when conventional inotropes and vasodilators were not effective. All ECMO were VA cannulated between the right atrium and the ascending aorta via sternotomy. An atrioseptectomy was also created for satisfactory left heart venting.

Results: The 5 patients were between 13 to 33-months of age. All had positive virus cultures of EV71. Their brain stem injuries were proved by MRI studies. Their left ventricle ejection fractions were only 24.9 ± 7.4% when manifesting cardiogenic shock. All ECMO were successfully weaned off in 48-94 hours. Their LVEF returned to 73.8 ± 3.9% at discharge. One became vegetative state, two received tracheostomy and gastrostomy and two were normal. Histologically, the atrial septectomised tissues showed only apoptosis and minimal leukocytes infiltrates.

Conclusions: Cardiogenic shock in severe EV71 infection can be stabilized by ECMO therapy, though these patients are still high risk for neurological sequelae.