Baby girl with hand, foot and mouth disease "escaped death's door" thanks to life-saving ECMO intervention

On August 5, Dr. Vo Thanh Luan, Deputy Head of the Department of Infectious Disease and Covid-19 Resuscitation, said that the 5-year-old patient received a combination of treatment measures including mechanical ventilation, IVIG infusion - an essential medicine for children with severe hand, foot and mouth disease, vasopressor and cardiac support drugs, and continuous blood filtration intervention.

However, the baby suffered severe heart damage (myocardial cell necrosis, cardiac enzymes increased more than 5,000 times normal) leading to arrhythmia, falling into ventricular tachycardia. The treatment team gave him multiple electric shocks, anti-arrhythmic drugs and cardiopulmonary resuscitation but there was no improvement.

Baby girl with limbs and mouth hernia from small child, ECMO intervention, life saving image 1 — The doctor discusses the baby's condition on the X-ray. (Photo provided by the hospital).

Doctors consulted with the entire hospital and found that the baby had severe heart and lung damage but was still neurologically responsive, so they decided to intervene with ECMO. This extracorporeal membrane oxygenation device is the weapon and last resort for respiratory support for critically ill patients, and has contributed to the spectacular resuscitation of many patients with Covid-19, myocarditis, etc.

According to doctors, when preparing for ECMO intervention, the baby's heart gradually weakened, the heart rate decreased and became erratic, and blood pressure dropped continuously. The on-duty team had to take turns performing cardiopulmonary resuscitation, external cardiac massage, and urgently install and operate the extracorporeal circulation system for the baby girl.

Previously, the 5-year-old patient had a headache, high fever and did not respond to antipyretics. The next day, the child still had a high fever, was drowsy, had shaking hands and feet, was startled many times when awake, had difficulty breathing, and had purple rashes all over his body. The lower level hospital diagnosed the child with grade 4 hand, foot and mouth disease, intubated, provided respiratory support and transferred him to Children's Hospital 2.

After 5 days of implementing this technique along with active supportive treatments such as mechanical ventilation, blood filtration, vasopressors, cardiac support, nutrition, infection control..., the baby's condition improved, heart damage gradually recovered, other organs and nerves stabilized, and he understood medical orders. The stool test result was positive for EV71 - a virus strain that causes severe hand, foot and mouth disease, with a much higher risk of death than other agents, and has caused many major epidemics. After three weeks of treatment, the baby's health has stabilized, his nerves have improved, he is eating normally, and is expected to be discharged soon.

Head Doctor Do Chau Viet said that this place receives and treats severe hand, foot and mouth disease, and most children respond well to the current treatment regimen. This particular child patient is a special case, the first in the hospital and in the whole country to use ECMO as a life-saving measure.

Doctors recommend that parents should closely monitor the signs of severe hand, foot and mouth disease that require immediate hospitalization for timely emergency care, including: high fever that is difficult to reduce, fever over 39 degrees Celsius, fever for more than two days; startled, trembling limbs, staggering, weak limbs; frequent vomiting; lethargy, drowsiness; rapid breathing, abnormal breathing; cold hands and feet, sweating, purple rash on the skin.

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