Paracorporeal pulsatile biventricular assist device versus extracorporal membrane oxygenation–extracorporal life support in adult fulminant myocarditis

Abstract

In our experience extracorporeal membrane oxygenation is as efficient as use of a biventricular assist device as a bridge to recovery for patients with fulminant myocarditis-related cardiogenic shock and facilitates renal and hepatic recovery on support.

Venoarterial Extracorporeal Membrane Oxygenation for Acute Fulminant Myocarditis in Adult Patients: A 5-Year Multi-Institutional Experience

“…Published VA-ECMO weaning rates due to cardiac recovery in AFM have ranged from 66% to 100% with a survival to hospital discharge ranging from 60% to 100% (Table 5). Our findings showed a weaning rate of 81% and discharge rate of 72% in the overall patient population, in accordance with published series [3,7,9,12] and confirming that a limited number of successfully weaned patients may still have a poor outcome due to major complications (Table 5). Our inhospital survival rate was slightly better than the one recently reported from the Extracorporeal Life Support Organization (ELSO) Registry, but it should be highlighted that our experience focused on the past 5 years, and more importantly included the most updated ECMO technology, whereas the ELSO Registry has provided results starting from 1995 [6].…”

“…On occasion, however, a more malignant course might occur with refractory hemodynamic compromise, ultimately leading to patient death if no mechanical cardiocirculatory support is promptly instituted [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15]. Available epidemiologic information indicates that acute myocarditis is a rare cardiovascular pathologic process, involving mostly young female patients and accounting for 10% of patients with newly developed cardiac compromise, and responsible for 8% to 12% of sudden deaths in young adults [1,2,15,17].…”

“…Our study population was characterized by AFM and was expected to have a lethal outcome if not aggressively and rapidly treated. The efficacy of VA-ECMO in critical AFM cases has been consistently proved to be highly advisable and effective on the basis of the ease and rapidity of application, on biventricular and respiratory support provided, and, on a more limited resource allocation, concomitantly providing a bridge to recovery or to more aggressive treatments [4][5][6][7][8][9][10][11][12][13][14]. Published VA-ECMO weaning rates due to cardiac recovery in AFM have ranged from 66% to 100% with a survival to hospital discharge ranging from 60% to 100% (Table 5).…”

“…Aggressive pharmacologic therapy and intraaortic balloon pump (IABP) are often insufficient, and mechanical circulatory support may therefore account for the unique means capable of sustaining the failing heart and providing time to enhance heart recovery or to more advanced therapies if adequate native cardiac function is not eventually restored [1][2][3]. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) has been shown to provide prompt and effective support in these circumstances [3][4][5][6][7][8][9][10][11][12][13][14]. Published series of VA-ECMO in AFM are, nonetheless, limited in terms of patient number and late outcome [3][4][5][6][7][8][9][10][11][12][13][14].…”

“…Venoarterial extracorporeal membrane oxygenation (VA-ECMO) has been shown to provide prompt and effective support in these circumstances [3][4][5][6][7][8][9][10][11][12][13][14]. Published series of VA-ECMO in AFM are, nonetheless, limited in terms of patient number and late outcome [3][4][5][6][7][8][9][10][11][12][13][14]. The aim of this study was, therefore, to analyze through a multicenter investigation the in-hospital and results after discharge in AFM patients who require VA-ECMO due to severe cardiocirculatory impairment.…”