Use of Extracorporeal Membrane Oxygenation (ECMO) in Acute Myocarditis - Insights from a National Inpatient Database

Abstract

Purpose Acute myocarditis can be a challenging entity to manage, and may require the use of extracorporeal membrane oxygenation (ECMO), if it is severe enough. However, there is a lack of large, nationally representative studies examining the use of ECMO in patients with acute myocarditis. In this study we used a large national inpatient database to investigate the use of ECMO in acute myocarditis. Methods We queried the 2013-14 National Inpatient Sample for all adult patients (aged 18+ years) admitted with a diagnosis of acute myocarditis using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes 422.0, 422.9x and 429.0, and patients requiring ECMO use (ICD-9-CM code 39.65). We then used complex samples multivariable regression to identify predictors of ECMO use. All results are weighted, and adjusted odds ratios (aOR) are presented with 95% confidence intervals (CI). SPSS version 25 (SPSS, IBM) was used for all statistical analyses. Results We identified 16,590 patients (weighted) with an admission diagnosis of acute myocarditis. Of these, 200 (1.2%) required ECMO. Patients in the ECMO group were younger (mean age 40.1 +- 15.5 years vs non-ECMO 46.8 +- 18.3 years; P Conclusion In our analysis of a national inpatient database, we found that ECMO was utilized in a small percentage of hospitalizations for acute myocarditis, and was associated with significantly increased mortality. However, mortality associated with ECMO use in our study may be related to more severe presentation of acute myocarditis. Further work is needed to identify predictors of improved survival in patients with acute myocarditis who require ECMO.