Retrospective Analysis of ECMO for Acute Fulminant Viral Myocarditis

Abstract

Background The inflammation or degeneration of the heart muscle myocarditis may be fatal. This disease often goes undetected. It may also disguise itself as ischemic valvular or hypertensive heart disease. Here we report eight cases of acute fulminant viral myocarditis suffering from low cardiac output ARDS Acute respiratory distress syndrome formation and successfully treated with ECMO Extra corporeal membrane oxygenation.Methodology All the cases were admitted in the emergency coronary care unit with severe respiratory distress poor hemodynamics and ECHO examination revealed low Left ventricle Ejection Fraction LVEF15-20. Veno - Arterial ECMO was initiated with femoro-femoral cannulation with distal limb perfusion. On ECMO support the hemodynamics were stabilized with no inotropic support. The heart and lungs were given adequate rest time for recovery by maintaining total cardiac output on ECMO. The average ECMO support was 84.2 plusmn 4 hours. Maquet Quadrox PLS Sorin Dideco ECMO oxygenators with rotaflow centrifugal pump were used. Delta pressure pre-pump pressures were continuously monitored.Results Out of the eight cases put on VA ECMO for viral myocarditis seven were successfully weaned off and were discharged success rate of 87.5. Soon after the initiation of ECMO the arterial saturation reached the normal levels. The serum lactate levels which were high gt6 mmolL prior to initiation of ECMO remarkably came down to lt2 mmolL after 24 hours. Seven patients were weaned off and decannulated in the operating room. One patient required LV decompression by Balloon Atrial Septostomy in the Hybrid OR and was successfully weaned off after 48 hours. One patient succumbed due to continuous low cardiac output which was irreversible with full blown septicemia and was not responding to ECMO and medications.Conclusion Peripheral VA-ECMO support is very effective in optimizing myocardial recovery for the treatment of refractory acute fulminant viral myocarditis when maximal conventional supports are ineffective.