Nghe An General Hospital saves post-Covid-19 patient with ECMO technique

Patient D.TL was treated with ECMO VA technique. Photo: Tran Phuong

March 21, Intensive Care Unit,Nghe An General Hospitalreceived patient D.TL, born in 1975, transferred from Vinh City General Hospital, with diagnosis: ARDS pneumonia - TD myocarditis/post Covid-19 on day 10.Patient Đ.TL had a history of Covid-19 infection since March 1. After self-monitoring his health at home, on March 8, the patient's rapid test result was negative. The patient had no underlying medical conditions.

Treated at the Intensive Care Unit, Nghe An General Hospital, the patient was intubated, given a ventilator, antibiotics, continuous blood filtration, and cardiac vasopressor. On March 24, the patient's condition worsened, with severe arrhythmia and progressive heart failure. Patient Đ.TL had a coronary angiogram with no lesions, a temporary pacemaker was placed, and he was transferred to the intensive care unit for further treatment. On March 25, the patient's heart failure progressed critically, with severe arrhythmia.

Faced with serious developments and a high risk of patient death, the Intensive Care Unit held a hospital-wide consultation, chaired by Associate Professor, Dr. Nguyen Van Huong - Hospital Director; with consultation from experts from the Intensive Care Center, Bach Mai Hospital, and the Vietnam Heart Institute.

Myocarditis is known as an inflammation of the heart muscle cells and common dangerous complications are ventricular arrhythmia, severe acute heart failure, and even fatal cardiogenic shock. The cause is mainly attributed to viruses (accounting for > 50% of cases, myocardial damage is not only caused by toxins from the virus itself but also originates from the body's response to this microbiological agent). Myocarditis caused by SARS-CoV-2 is also described similarly to the group of diseases caused by viruses, diverse and not characterized by any symptoms.

Patient Đ.TL was diagnosed with Myocarditis complicated by cardiogenic shock with severe arrhythmia - Pneumonia/ Post-Covid-19. The patient was prescribed ECMO VA treatment. (This is a method of using circulation and oxygen exchange outside the body to support vital functions in patients with circulatory failure). With the same operating principle as an artificial heart-lung machine, ECMO will help maintain the patient's life, while creating time for the heart to rest and recover.

At 2:00 p.m. on March 25, the Department of Intensive Care coordinated with the Department of Thoracic and Vascular Surgery to deploy ECMO VA for the patient. Patient D.TL received ECMO VA, continuous blood filtration, antibiotics, blood pressure control, anticoagulation with ECMO, electrolyte adjustment, fluid balance, nutrition, albumin replacement, red blood cell and platelet transfusion, inter-hospital consultation, and ultrasound to assess heart function.

At this time, the patient's health has gradually recovered and he will soon be discharged from the hospital. Photo: Tran Phuong

After receiving ECMO support combined with continuous blood filtration and mechanical ventilation, the patient's health improved. After 5 days of intensive treatment, the patient was taken off ECMO VA, stopped mechanical ventilation, and had the temporary pacemaker removed. Currently, the patient's heart function has recovered well, breathing is stable, general condition is better and it is expected that he will be discharged in the coming days.

According to medical experts: Myocarditis caused by SARS-CoV-2 is also described similarly to the group of diseases caused by viruses, diverse and not characterized by any symptoms. The success of the above case shows the effectiveness of the method of extracorporeal membrane oxygenation (ECMO) in the most severe acute myocarditis.

This is the second case in which Nghe An General Hospital has implemented ECMO. The successful application of this technique has opened up many opportunities to save the lives of critically ill patients in the North Central region, especially in the context of the complicated developments of the Covid-19 pandemic.