Hantavirus cardiopulmonary syndrome: implications for transport management and care.

INTRODUCTION: A 14-year-old boy with cardiorespiratory failure was referred for air medical transport. The complexity of care during air medical transport and subsequent diagnosis of hantavirus warranted a post hoc review of the literature to establish optimal transport management criteria.

METHODS: This is a case report and literature review, defining epidemiology, presentation, cause of pulmonary edema and cardiac failure, management, and outcome.

RESULTS: Hantavirus cardiopulmonary syndrome is rare in children. Severe cases have manifestations similar to those seen in adults: atypical pneumonia progresses to respiratory failure with severe pulmonary edema and associated circulatory compromise. Mechanical ventilation, judicious fluid replacement, and early inotropic therapy are central to transport management. Critical care may require extracorporeal membrane oxygenation (ECMO). Mortality remains high, although it appears to be lower in children younger than 14 years.

CONCLUSION: Hantavirus infection commonly progresses to a cardiopulmonary syndrome, in which mortality is high. Optimal management includes: early suspicion/recognition based on characteristic clinical course and history; provision of oxygen and comprehensive ventilatory support; judicious fluid replacement; early and intensive inotropic therapy; prompt referral to an appropriate level of care; skillful interfacility transport. Definitive care can involve ECMO.