Abstract 16118: Extracorporeal Membrane Oxygenation for Children With Myocarditis: An Update From the Elso Registry

Abstract

Introduction: Acute myocarditis causing cardiogenic shock commonly requires mechanical circulatory support. While it has been shown to be associated with survival to discharge in reports comparing indications for ECMO, our understanding of the impact of patient care related factors on outcomes remains limited by single center analyses and lack of consensus on diagnostic criteria. We therefore aimed to describe ECMO utilization and outcomes for pediatric patients requiring ECMO for acute myocarditis by sampling contemporary cohorts from the Extracorporeal Life Support Organization registry. Methods: Data was requested from ELSO database to include all pediatric patients under 19 years of age with a diagnosis of acute myocarditis who received ECMO support between 2007 and 2018. Index cases were utilized while non-VA ECMO runs were excluded. Primary outcome was mortality. Characteristics of the population are compared by mortality using t-test, Wilcoxon rank sum test, or Fisher’s exact test. Univariate analysis was performed. Multivariate logistic regression was used for significant factors in the unadjusted logistic regression. Results: We analyzed 924 ECMO runs after applying exclusion criteria. Overall survival for the cohort was 69%. Patients experiencing cardiac arrest requiring ECMO (ECPR) were less likely to survive compared to non-ECPR patients (61% vs 72%, p<0.01). The time from intubation from ECMO was found to be associated with mortality, with increased time from intubation to ECMO cannulation in survivors of 6hrs [IQR 2-22] vs non-survivors 9.5hrs [IQR 2-33], p<0.01). Conclusions: The results of this multicenter analysis of ECMO utilization and outcomes for pediatric myocarditis reveal a lower likelihood of survival when the indication for ECMO cannulation is ECPR. Increased time from intubation to ECMO cannulation may impact outcomes as much as markers of inadequate oxygen delivery. This suggests that earlier ECMO cannulation may improve outcomes for pediatric patients presenting with acute myocarditis. Further investigation into the factors distinguishing ECPR from non-ECPR patients with myocarditis are needed.