ESPN 50th Annual Meeting

ESPN 2017


 
HUS induced cardiac failure is reversible using cardiopulmonary bypass as rescue
RENé ANDERSEN 1 JESPER BJERRE 1 JOHAN POVLSEN 2 METTE VEIEN 3 KONSTANTINOS KAMPERIS 1 SøREN RITTIG 1

1- PEDIATRICS AND ADOLESCENT MEDICINE, AARHUS UNIVERSITY HOSPITAL
2- DEPARTMENT OF RENAL MEDICINE, AARHUS UNIVERSITY HOSPITAL
3- DEPARTMENT OF ANESTHESIOLOGY, AARHUS UNIVERSITY HOSPITAL
 
Introduction:

The extra-renal involvement in hemolytic uremic syndrome (HUS) includes gastrointestinal, pancreatic, hepatic, neurological and cardiac symptoms. The mortality in HUS patients of 3-5% is primarily attributed to complications related to CNS and the heart. In the case presented here , we illustrate that severe cardiac involvement in a patient with HUS is potentially reversible using cardiopulmonary bypass as rescue.

Material and methods:

Data are collected from the boy`s medical journal. 

Results:

A 12 years old boy was diagnosed with EHEC induced HUS related to E. Coli type 2A. The patient developed anuria, hypertension of 150/105 mmHg, and had neurological symptoms with lethargy, confusion and later a tonic-clonic seizure successfully treated with midazolam. Blood samples showed renal insufficiency with a creatinine of 3.98 mg/dL, thrombocytopenia of 47*109/L, LDH of 3620 IU/L, low haptoglobin < 20 mg/dL, anemia of 10.0 g/dL and schistocytes were seen on blood smears. Peritoneal dialysis was initiated without complications. Serum potassium was normal. At day 3, the patient had cardiac arrest twice. Troponin-T, creatine kinase, and creatine kinase-MB were significantly increased. The second episode of cardiac arrest was irreversible to advanced CPR and a cardiopulmonary bypass circuit was established to provide cardiac output. Declining cardiac pump function to a near non-contractile state with an ejection fraction below 10% was observed by echocardiography. This persisted during the following days. However, after seven days on the cardiopulmonary bypass circuit, the myocardium slowly recovered function. Three days later, the cardiopulmonary bypass was successfully discontinued and echocardiography showed near-normal ejection fraction and ECG showed sinus rhythm.

Conclusions:

Fatal outcome may be the result of severe cardiac involvement in HUS patients. The present case illustrates the need for intensive supportive care including the use of cardiopulmonary bypass as the cardiac symptoms in HUS patients may be reversible.