Early Prediction Model for Successful Bridge to Recovery in Patients With Fulminant Myocarditis Supported With Percutaneous Venoarterial Extracorporeal Membrane Oxygenation　― Insights From the CHANGE PUMP Study ―

Abstract

quickly and easily and is less invasive than a VAD, which requires a surgical operation. 4,5 VA-ECMO is considered a short-term but effective and useful circulatory support technique in urgent clinical situations. 6 Previous reports have shown that approximately 50-70% of FM patients experience spontaneous recovery during VA-ECMO support. 4,7-11However, VA-ECMO cannot reduce the left ventricular afterload and may cause pulmonary congestion, which is a disadvantage for cardiac recovery. 5 Additionally, it has insufficient power for circulatory support compared with F ulminant myocarditis (FM) is characterized by rapidly progressive myocardial inflammation leading to circulatory collapse. 1,2 A certain number of patients cannot be adequately supported by conventional inotropic therapy, 3 and despite recent progress in both medical knowledge and technology, treatment of these patients depends on mechanical circulatory support (MCS), including venoarterial extracorporeal membrane oxygenation (VA-ECMO) and ventricular assist devices (VADs). Background: Cardiac recovery and prevention of end-organ damage are the cornerstones of establishing successful bridge to recovery (BTR) in patients with fulminant myocarditis (FM) supported with percutaneous venoarterial extracorporeal membrane oxygenation (VA-ECMO). However, the timing and method of successful BTR prediction still remain unclear. We aimed to develop a prediction model for successful BTR in patients with FM supported with percutaneous VA-ECMO.

Inflammation in myocardial disease: From myocarditis to dilated cardiomyopathy

“…At present, because of progress in medical technology approximately 50% of patients with fulminant myocarditis survive to discharge in Japan . However, there are few current long‐term follow up surveys of outcomes and histological changes in these patients .…”

Prognostic Value of Electrocardiography in Patients With Fulminant Myocarditis Supported by Percutaneous Venoarterial Extracorporeal Membrane Oxygenation ― Analysis From the CHANGE PUMP Study ―

“…10 In that study we focused on the recovery of cardiac function and changes in biochemistry markers during the 48 h after VA-ECMO initiation. As we have clarified in the present study, however, ECG may have the potential to provide some prognostic information during Tables 1,2.…”

“…10 That model, however, focused on the recovery of cardiac function and changes in biochemical markers. From a clinical standpoint, distinguishing abnormalities on electrocardiogram (ECG) is also important for the daily practice and management of FM patients.…”

VA‐ECMO Support in Nonsurgical Patients With Refractory Cardiogenic Shock: Pre‐Implant Outcome Predictors

“…Although RCS represents the majority of patients on VA‐ECMO , the majority of studies have focused on postcardiotomy patients . Remaining studies have evaluated nonsurgical subgroups or a combination of nonsurgical and surgical populations , which complicates interpretation as the two latter cohorts have different pathophysiological mechanisms. Independent pre‐VA‐ECMO outcome predictors in an unselected nonsurgical population with RCS have only scarcely been identified as studies have mainly included variables from both before and after initiation of VA‐ECMO in the analysis , or have not reported rates of missing data or having substantially incomplete data .…”