Abstract 13058: Outcomes With Venoarterial Extracorporeal Membrane Oxygenation for Acute Myocarditis: A 20-year Experience From the ELSO Registry

Abstract

Introduction: Acute myocarditis can result in severe hemodynamic compromise requiring venoarterial extracorporeal membrane oxygenation (VA-ECMO). Outcomes with VA-ECMO and factors associated with mortality are not well described and mostly confined to small cohorts in this population. Methods: We queried the ELSO registry from 2000-2020 for adults with acute myocarditis undergoing VA-ECMO support, excluding patients with non-cardiac support, central cannulation, and multiple ECMO runs. The primary outcome was in-hospital mortality, and secondary outcomes were the incidence of major adverse events during ECMO. We used multivariable logistic regression modeling to examine factors associated with in-hospital mortality. Results: Among 956 patients with acute myocarditis supported with VA-ECMO, 338 (36.2%) died before hospital discharge. The patients had a mean age of 40.7 years, 51.0% were male, 42.5% of Asian race, mean weight was 73.7 kg, and 31.6% suffered a cardiac arrest before support. Prior to ECMO initiation the mean arterial pressure was 63.5 mmHg, pH 7.28, and 26.1% required >2 vasopressors. After multivariable modeling, risk factors for mortality were earlier year of support, older age, higher weight, extracorporeal cardiopulmonary resuscitation modality, lower blood pressure, lower pH, and need for >2 vasopressors prior to VA-ECMO initiation ( Figure: Panel A ). Major complications during VA-ECMO support were more common among non-survivors ( Figure: Panel B ). Conclusions: For patients with myocarditis, outcomes with VA-ECMO are favorable with nearly 2/3 of patients surviving to discharge. Predisposing factors for inpatient mortality include markers of illness severity, including lower blood pressure, lower pH, need for multiple vasopressors, and ongoing cardiopulmonary resuscitation. Use of VA-ECMO prior to severe hemodynamic collapse and minimizing complications during ECMO support could improve outcomes in this population.