OXY HOÁ MÁU QUA MÀNG NGOÀI CƠ THỂ TĨNH MẠCH - ĐỘNG MẠCH SONG SONG ĐIỀU TRỊ VIÊM CƠ TIM TỐI CẤP CÓ LOẠN NHỊP THẤT KHÁNG TRỊ, BÁO CÁO CA BỆNH

Abstract

Objective: To report a case of refractory ventricular arrhythmia secondary to fulminant myocarditis successfully treated with parallel veno-arterial extracorporeal membrane oxygenation (parallel V-A ECMO) combined with therapeutic plasma exchange as an adjunctive treatment for refractory ventricular arrhythmia.

Methods: A 36-year-old female patient was admitted with acute myocarditis. She subsequently developed acute heart failure, cardiogenic shock, and ventricular arrhythmia requiring circulatory support with V-A ECMO. As the ventricular arrhythmia became refractory, a second V-A ECMO system was initiated in parallel, and therapeutic plasma exchange was performed to support arrhythmia control.

Results: After 3 days of treatment with parallel V-A ECMO and two sessions of plasma exchange with a total volume of 12 liters of fresh frozen plasma, the ventricular arrhythmia improved, allowing removal of the second V-A ECMO system. After 7 days of ECMO support, myocardial contractility improved and the first V-A ECMO system was successfully discontinued. The patient was subsequently transferred to the Cardiology Department, with recovery of cardiac contractile function, and was discharged with a left ventricular ejection fraction of 50%.

Conclusion: Parallel ECMO may be safer than hybrid ECMO and may help achieve adequate tissue perfusion in patients with fulminant myocarditis complicated by refractory ventricular arrhythmia. Therapeutic plasma exchange, by reducing circulating myocardial stimulatory substances, may serve as an adjunctive treatment option for refractory ventricular arrhythmia.