P0261 / #2147: MANAGEMENT OF DRUG REFRACTORY ARRHYTHMIA TREATED WITH EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO) SECONDARY TO COVID-19 INFECTION

Abstract

AIMS & OBJECTIVES: Myocarditis caused by SARSCoV2 is one of the causes of death in this pandemic, mainly due to arrhythmias, leading to heart failure and cardiogenic shock. The use of ECMO is one strategy as a bridge to treatment. Our objective is to describe the case of a patient with arrhythmias secondary to COVID-19 and the strategies used. METHODS: Fourteen years old male started with a retrosternal burning pain, palpitations and dyspnea, was admitted to the emergency department. An electrocardiographic trace was taken showing ventricular tachycardia with hemodynamic compromise, synchronized cardioversion was performed. Management with amiodarone, metoprolol and lidocaine is added. It was decided to enter therapeutic catheterization for ablation. Due to refractoriness to treatment, it is left with infusion of amiodarone, lidocaine and esmolol. Evolves into cardiogenic shock, requiring aminergic management with epinephrine, vasopressin, milrinone and levosimendan infusion. RESULTS: It was decided to start with extracorporeal membrane support as a management for arrhythmia refractory to pharmacological treatment. Required for 80 hours. Myocarditis is suspected, and PCR test for SARS-CoV2 is requested, which is obtained as positive. Continuing with the presence of rhythm alterations when attempting to withdraw drug management, it was decided to enter the hemodynamic room to perform ablation again, which was performed successfully. CONCLUSIONS: Arrhythmias secondary to COVID-19 have been described in adult patients. However, the manifestations of this infection in pediatric patients differ in several aspects, so it is important to study this pathology as a probable manifestation of great impact on the survival of the pediatric patient.