Fainting, cardiac arrest after flu-like symptoms
About two weeks before the incident occurred, the 17-year-old male student developed symptoms such as body aches and pains, runny nose. Because the symptoms were not special, the family did not think he was having serious problems.
During the summer vacation, the male student took the opportunity to work part-time, helping his uncle. About 15 minutes before being hospitalized, he suddenly fainted and fell into a state of circulatory arrest.
The family quickly took him by taxi to a medical facility. Here, doctors performed cardiac arrest resuscitation for about 45 minutes.
After 45 minutes, the heart had a pulse return. However, the patient's condition was still particularly critical and he was transferred to Thanh Nhan Hospital to continue intensive resuscitation.
The heart only contracts 10-15%, lungs are severely damaged
When admitted to the Intensive Care Unit, Thanh Nhan Hospital, the patient was on a ventilator through an endotracheal tube, with a lot of blood flowing through the airways, jaw-dropping and cyanosis.
Heart rate is about 145-150 beats/minute, blood pressure is only 50-60/20-30 mmHg. Although ventilated with maximum oxygen concentration, SpO2 only reaches about 76-80%. Blood gas shows severe metabolic acidosis.
Chest CT scan results recorded right lung contusion, pneumothorax and right pleural effusion. Through pleural drainage, there was a lot of fresh red blood mixed with blood clots.
The biggest risk at that time was that the patient died immediately," said Master, resident doctor Pham Huy Khanh, Department of Intensive Care, Thanh Nhan Hospital.
Through evaluation, doctors determined that the male student had severe myocarditis causing heart shock, multiple organ failure, and serious lung damage. The heart's contractility function is only about 10-15%.
According to Dr. Khanh, this is a particularly difficult situation because the patient faced two serious problems at the same time: the heart almost lost its ability to contract, while the lungs also did not ensure oxygen exchange.
“Patients with heart shock due to myocarditis are very severe, the heart is almost completely contracted. Meanwhile, the lungs are very bad, SpO2 is only about 76%. If only using one type of ECMO, the effectiveness is not guaranteed,” Dr. Khanh said.
Faced with a critical situation, the team decided to deploy ECMO V-A-V - a method to support both circulation and respiration.
In addition to ECMO, patients are actively treated with many measures such as mechanical ventilation, blood filtration, use of cardiovascular support drugs, pleural drainage, blood transfusion, body temperature control, nutrition and tracheostomy.
In the following days, the patient developed blood clotting disorders, heavy bleeding at the intervening sites and in the bronchi. At times, excessive bleeding made the lungs almost unable to be ventilated.
The patient continued to have gastrointestinal bleeding, at times the amount of blood lost was about 2,000 ml. Doctors had to perform emergency endoscopy right at the bed to find and handle the bleeding location.
Throughout the treatment process, patients are closely monitored and treated simultaneously for many problems in circulation, breathing, blood clotting, bleeding as well as organ function.
For a patient who has had prolonged circulatory arrest, the risk of brain damage is a problem that doctors are particularly concerned about.
The patient's body temperature was controlled for 12 days, combined with intensive care and close monitoring of neurological function. After stressful days, positive signals gradually appeared.
On August 28, after nearly a month of treatment since being admitted to the hospital, the male student was discharged and transferred to the Heart Hospital to continue monitoring and intensive treatment of cardiovascular disease.
According to Dr. Pham Huy Khanh, the case of the 17-year-old male student is a warning about the risk of myocarditis in young people.
