Abstract

Background: Acute fulminant myocarditis (AFM) is a serious disease that progresses rapidly, and leads to failing respiratory and circulatory systems. When medications fail to reverse the patient’s clinical course, extracorporeal membrane oxygenation (ECMO) is considered the most effective, supportive and adjunct strategy. In this paper we analyzed our experience in managing AFM with ECMO support. Methods: During October 2003 and February 2017, a total of 35 patients (≥18 years) were enrolled in the study. Twenty patients survived, and another 15 patients expired. General demographics, the hemodynamic condition, timing of ECMO intervention, and laboratory data were compared for the survival and non-survival groups. Univariate and multivariate Cox regression analyses were performed to identify the associations with in-hospital mortality following ECMO use in this situation. Results: The survival rate was 57.1% during the in-hospital period. The average age, gender, severity of the hemodynamic condition, and cardiac rhythm were similar between the survival and non-survival groups. Higher serum lactic acid (initial and 24 h later), higher peak cardiac biomarkers, higher incidence of acute kidney injury and the need for hemodialysis were noted in the non-survival group. Higher 24-h lactic acid levels and higher peak troponin-I levels were associated with in-hospital mortality. Conclusions: When ECMO was used for AFM, related cardiogenic shock and decompensated heart failure, higher peak serum troponin-I levels and 24-h serum lactic acid levels following ECMO use were independently associated with in-hospital mortality.

Highlights

  • Patients with acute myocarditis often present with a wide range of signs and symptoms including asymptomatic electrocardiographic modifications, chest pain, dyspnea or palpitations, and overt cardiac failure or sudden cardiac death, usually affecting children [1]

  • Acute fulminant myocarditis (AFM) is a rapidly progressive life-threatening disease accompanied by cardiogenic shock (CS) and decompensated heart failure (HF); AFM sometimes requires mechanical circulatory support if conventional therapy cannot support the circulatory condition [4]

  • Due to the limited availability of data on the clinical outcomes of extracorporeal membrane oxygenation (ECMO) use for adults with AFM, we investigated the clinical outcomes and explored the associations between clinical factors and in-hospital mortality in these patients

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Summary

Introduction

Patients with acute myocarditis often present with a wide range of signs and symptoms including asymptomatic electrocardiographic modifications, chest pain, dyspnea or palpitations, and overt cardiac failure or sudden cardiac death, usually affecting children [1]. Previous studies have shown that mechanical circulatory support can save patients with CS resulting from AFM, and achieve an overall survival rate of 54.5–74.5% [5,6,7]. In children with AFM, initial serum troponin-I cutoff values greater than 14.21 ng/mL may indicate the need for extracorporeal membrane oxygenation (ECMO) support [10]. Higher serum lactic acid (initial and 24 h later), higher peak cardiac biomarkers, higher incidence of acute kidney injury and the need for hemodialysis were noted in the non-survival group. Conclusions: When ECMO was used for AFM, related cardiogenic shock and decompensated heart failure, higher peak serum troponin-I levels and 24-h serum lactic acid levels following ECMO use were independently associated with in-hospital mortality

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