Management of ECPELLA for cardiopulmonary support in enterovirus 71-associated brainstem encephalitis: a case report

Background Enterovirus 71 (EV71) is a major causative agent of hand-foot-and-mouth disease and herpangina, typically resulting in mild, self-limiting illness. However, a subset of infections may progress to severe central nervous system (CNS) complications, including aseptic meningitis, encephalitis, brainstem encephalitis, and acute flaccid paralysis. In rare cases, EV71 infection may lead to cardiopulmonary failure, which further complicates clinical management and prognosis. Case presentation : We report the case of a 13-year-old boy who developed cardiopulmonary failure in the context of EV71 infection, requiring emergency hemodynamic support with ECPELLA therapy. The patient’s cardiac function and hemodynamic status improved progressively, allowing successful weaning from ECPELLA without adverse events. Cognitive function remained intact, and no signs of hypoxic-ischemic encephalopathy were observed. However, subsequent neurological assessment revealed flaccid quadriplegia, bulbar palsy, and multiple cranial nerve palsies. Magnetic resonance imaging demonstrated findings consistent with brainstem encephalitis and acute flaccid myelitis. EV71 was isolated from fecal samples, confirming the diagnosis of EV71-associated acute flaccid myelitis and brainstem encephalitis. At follow-up, the patient exhibited persistent bulbar dysfunction, residual limb weakness, and an abnormal gait. Conclusions This case highlights the potential severity of EV71-associated neurological and cardiopulmonary complications. The application of percutaneous cardiopulmonary support, specifically ECPELLA, was instrumental in stabilizing the patient’s hemodynamics and mitigating further systemic deterioration. ECPELLA therapy may offer hemodynamic benefits in similar presentations by reducing afterload and facilitating left ventricular decompression, underscoring its potential utility in managing fulminant cardiopulmonary collapse in EV71 encephalitis.