Predictors of Extracorporeal Membrane Oxygenation Support for Children with Acute Myocarditis

Abstract

The clinical presentation of acute myocarditis in children may range from asymptomatic to sudden cardiac arrest. This study analyzed the clinical spectrum of acute myocarditis in children to identify factors that could aid primary care physicians to predict the need for extracorporeal membrane oxygenation (ECMO) earlier and consult the pediatric cardiologist promptly. Between October 2011 and September 2016, we retrospectively analyzed 60 patients aged 18 years or younger who were admitted to our pediatric emergency department with a definite diagnosis of acute myocarditis. Data on demographics, presentation, laboratory tests, electrocardiogram and echocardiography findings, treatment modalities, complications, and long-term outcomes were obtained. During the study period, 60 patients (32 male, 28 female; mean age, 8.8 ± 6.32 years) were diagnosed with acute myocarditis. Fever, cough, and chest pain were the most common symptoms (68.3%, 56.7%, and 53.3%, resp.). Arrhythmia and left ventricular ejection fraction (LVEF) < 60%, vomiting, weakness, and seizure were more common in the ECMO group than in the non-ECMO group, with statistical significance (P < 0.05). Female sex, vomiting, weakness, seizure, arrhythmia, and echocardiography showing LVEF < 60% may predict the need for ECMO. Initial serum troponin-I cutoff values greater than 14.21 ng/mL may also indicate the need for ECMO support for children with acute myocarditis.

Acute Myocarditis in Children: a 10-year Nationwide Study (2007–2016) based on the Health Insurance Review and Assessment Service Database in Korea

“…A previous study reported that ECMO was initiated in approximately 17% of the children who were hospitalized with myocarditis. 17) Another study in US that used the Pediatric Health Information System database reported that ECMO was initiated in 18.9% of children hospitalized with myocarditis. 6) The rate of ECMO use in our study was slightly lower than that in previous studies.…”

ECMO as an effective rescue therapeutic for fulminant myocarditis complicated with refractory cardiac arrest

“…ECMO was used in 16.7% and 7.4% of children in Taiwan and US, respectively, due to acute myocarditis. 13 , 14 According to the previous studies, 15 – 17 the following were indications for the ECMO therapy: 1) low blood pressure (systolic blood pressure <60 mmHg for children, and <50 mmHg for infants) despite an inotropic equivalent (IE, mg/kg/min = dopamine + dobutamine +15× milrinone +100 * epinephrine +100 * norepinephrine +100 * isoproterenol), >40 mg/kg/min support, 2) cardiac and pulmonary failure refractory to medical therapy, 3) cardiac arrest requiring continuous CPR, and 4) uncontrolled arrhythmia including VT and ventricular fibrillation. We conclude that children with FM requiring continuous CPR should definitely be considered for ECMO support, just as the case reported above.…”

Associations with the In-Hospital Survival Following Extracorporeal Membrane Oxygenation in Adult Acute Fulminant Myocarditis

“…Previous studies have reported that poor left ventricular systolic function and in-hospital arrhythmia were associated with poor short-term outcomes [ 8 , 9 ]. In children with AFM, initial serum troponin-I cutoff values greater than 14.21 ng/mL may also indicate the need for extracorporeal membrane oxygenation (ECMO) support [ 10 ]. However, most studies have focused on pediatric patients with AFM, and we hypothesized that the predictors of clinical outcomes would be similar in adult patients.…”