Clinical study of extracorporeal membrane oxygenation in patients with fulminant myocarditis

Abstract

Objective To explore the clinical effect of the extracorporeal membrane oxygenation (ECMO) in patients with fulminant myocarditis (FM). Methods Observing 8 FM patients admitted to Critical Care Medicine in Hangzhou First People's Hospital from September 2009 to October 2015. All patients accepted vein-artery extracorporeal membrane oxygenation (VA-ECMO) after unsatisfactory results with conventional therapy. The levels of creatine kinase, creatine kinase isoenzyme MB (CK-MB), troponin Ⅰ (TNⅠ), aspartate aminotransferase (AST), actate dehydrogenase(LDH), serum creatinine, blood lactic acid, cardiothoracic ratio and left ventricular ejection fraction (LVEF) before and after VA-ECMO were compared. Meanwhile, all the patients were divided into the surgical group and ultraphonic group accroding to catheter of femoral arterio-venous, 4 patients in each group, and the time of insertion and the occurrence of complications were compared. Results Six patients were successfully weaned off and fully recovered cardiac function, while 2 patients eventually died because of heart function irreversible. The levels of creatine kinase [(586 ± 461) U/L vs. (90 ± 38) U/L, t = 2.721, P = 0.042], serum creatinine[(153 ± 70) μmol/L vs. (966 ± 20) μmol/L, t = 3.866, P = 0.012], blood lactic acid [(6.25 ± 3.67) mmol/L vs. (1.23 ± 0.29) mmol/L, t = 3.236, P = 0.023] and LVEF [(0.21 ± 0.16) vs. (0.47 ± 0.05), t = 4.416, P = 0.007] showed significant differences before and after VA-ECMO. The time of insertion in the ultraphonic group was much shorter than that in the surgical group [(24 ± 5) min vs. (72 ± 10) min, t = 7.908, P = 0.004], and no other adverse reactions and complications happened. Conclusion ECMO is one of the most effective mechanical circulation support devices, and combined with ultrasound can be better in FM patients. Key words: Extracorporeal membrane oxygenation; Cardiomyopathies; Fulminant myocarditis