Abstract
Extracorporeal membrane oxygenation (ECMO) is increasingly used for cardiogenic shock from many causes. There is a high mortality in this population; however, picking the right patients for support may lead to improved outcomes. We sought to compare survival in patients with myocarditis with other diagnoses, and to identify variables that might be able to predict outcome. From our institutional ECMO database, we analyzed laboratory and outcomes data for 61 patients initiated on VA-ECMO to determine whether patients being treated for myocarditis had improved outcomes compared to non-myocarditis patients. We utilized t-test and wilkson-rank sum for parametric and non-parametric data. We analyzed 61 patients supported exclusively with VA-ECMO between September 2006 and October 2015. From those 61 patients, 8 were treated for myocarditis. At 30 days, 5 were successfully weaned from support (63%), 1 was transplanted (12%) and 2 expired (25%). This contrasts with the non-myocarditis cohort, which had a 66% 30-day mortality rate (p=0.05). The median duration of support was 8 [IQR 4.25; 18.5] days in the myocarditis cohort compared to 3 [IQR 2; 8] days in the overall cohort (p=0.02). We collected 13 laboratory variables (CBC, sodium, BUN, creatinine, bicarbonate, AST, ALT, total bilirubin and lactic acid) obtained upon ECMO initiation. There were no significant differences found between the above parameters. Based upon this analysis, we were unable to detect laboratory variables that were associated with positive outcomes. Despite longer durations of support, it appears that patients with myocarditis have increased survival at 30 days when compared to patients supported on VA-ECMO for other indications. Patients treated with VA-ECMO for myocarditis have improved survival compared to other indications for VA-ECMO but a larger trial is needed to confirm this single-center data. Pre-implant laboratory parameters were not significantly different between myocarditis and non-myocarditis patients.
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