Extracorporeal membranous oxygenation support for acute fulminant myocarditis: Analysis of a single center's experience
Journal
European Journal of Cardio-thoracic Surgery
Journal Volume
40
Journal Issue
3
Pages
682-688
Date Issued
2011
Author(s)
Hsu K.-H.
Ko W.-J.
Abstract
Objectives: Acute fulminant myocarditis (AFM) is a disease category that is easily neglected. Circulatory mechanical support is sometimes required for this devastating condition. We analyzed our experience in managing AFM with mechanical circulatory support. Methods: We applied extracorporeal membrane oxygenation (ECMO) as a first-line rescue for AFM. The diagnosis was mainly derived from clinical results and biopsy. Results: Seventy-five patients were enrolled in the age range of 29.6 ± 18.6 years and the pediatric group (<18 years) comprised 32% (n = 24) of our patient group. Thirty-five patients (47%) underwent cardiopulmonary resuscitation (CPR) before ECMO. The indication for ECMO included high inotropic support 69% (n = 54) and continuous CPR at ECMO setup 31% (n = 23). The ECMO duration was 171 ± 121. h. Survival to discharge was 64% (n = 48), 61% in adult group, and 70.8% in pediatric group. Six patients were later bridged to ventricular assist device use (5 left ventricular assist device (LVAD) and 1 bi-ventricular assist device (BVAD)) but three died of multiple-organ failure. Three patients (4%) underwent heart transplantation and all of them survived to discharge. Resuscitation did not have a significant factor for survival. Only two patients (3%) developed late mortality due to a cardiac event. Conclusions: AFM still carries high mortality rates in spite of advanced mechanical support. Most of the survivors did not require transplantation and could return to good lifestyle. Due to its simplicity and effectiveness, ECMO can be a first-line tool to rescue this group of patients. ? 2011 European Association for Cardio-Thoracic Surgery.
SDGs
Other Subjects
acute fulminant myocarditis; adult; article; artificial ventilation; biventricular assist device; device; extracorporeal oxygenation; female; heart muscle biopsy; heart transplantation; hospital discharge; human; major clinical study; male; multiple organ failure; myocarditis; pediatrics; priority journal; resuscitation; survival; Acute Disease; Adolescent; Adult; Cerebrovascular Disorders; Child; Extracorporeal Membrane Oxygenation; Female; Follow-Up Studies; Heart Transplantation; Heart-Assist Devices; Humans; Male; Middle Aged; Myocarditis; Prognosis; Renal Dialysis; Renal Insufficiency; Retrospective Studies; Treatment Outcome
Type
journal article