Use of percutaneous cardiopulmonary support of patients with fulminant myocarditis and cardiogenic shock for improving prognosis

Kato, Shigeru; Morimoto, Shin-ichiro; Hiramitsu, Shinya; Nomura, Masatoshi; Ito, Teruo

doi:10.1016/s0002-9149(98)00931-x

Cited by 61 publications

(38 citation statements)

References 8 publications

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“…In this international registry encompassing 11 patients, 7 (63%) of them survived to the explantation of the device without heart transplantation (9). Although previous investigators already emphasized on the clinical usefulness of VA-ECMO (10)(11)(12), the study of Chen et al was the first report clearly outlining the advantage of ECMO over ventricular assist devices in the specific setting of cardiogenic shock, i.e., the possibility to provide a biventricular support of easy and rapid setup even in emergent cardiopulmonary resuscitation situations. Long-term left ventricular or biventricular assist device implantation is a more complicated, time-consuming and much more expensive and invasive operation.…”

Section: Introductionmentioning

confidence: 99%

Veno-arterial extracorporeal membrane oxygenation for cardiogenic shock due to myocarditis in adult patients

Pozzi¹,

Banfı²,

Grinberg³

et al. 2016

J. Thorac. Dis.

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Myocarditis is an inflammatory disease of the heart muscle with established histological, immunological and immunohistochemical diagnostic criteria. Different triggers could be advocated as possible etiologies of myocarditis such as viral and non-viral infections, medications, systemic autoimmune diseases and toxic reactions. The spectrum of clinical presentations of myocarditis is broad and varies from subclinical asymptomatic courses to refractory cardiogenic shock. The prognosis of patients with myocarditis depends mainly on the severity of clinical presentation. In particular, myocarditis patients developing cardiogenic shock refractory to optimal maximal medical treatment may benefit from the use of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) as a temporary mechanical circulatory support (MCS).The aim of the present report is to offer a review of the most important articles of the literature showing the results of VA-ECMO in the specific setting of cardiogenic shock due to myocarditis in adult patients. J Thorac Dis 2016;8(7):E495-E502 jtd.amegroups.com characterized by tissue hypoperfusion and multiorgan failure requiring prompt interventions. Initially refractory cardiogenic shock is supported with temporary MCS as a "bridge to decision" before considering the patient eligible for a long-term device implantation in case of no recovery. This general trend has been regularly highlighted by the Annual Reports of the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) (4,5). The implantation of long-term MCS in cardiogenic shock patients, i.e., INTERMACS Level 1 patients, fell since 2006 from 41% to 14%. As a consequence, there has been a considerable increase from 8% to 30% in the implantation of long-term MCS in INTERMACS Level 3 patients, i.e., stable but inotrope-dependent heart failure patients. In this subgroup of critically ill and unstable patients in cardiogenic shock, VA-ECMO allows, on the one hand, temporary hemodynamic stabilization with improvement of end-organ function and, on the other hand, gives the time to perform complementary diagnostic exams and to decide the therapeutic strategy in these high-risk candidates for immediate long-term MCS implantation (6). VA-ECMO could be implanted and removed directly at the bedside in the intensive care unit and offers a reasonable solution in term of cost-effectiveness.Patients who do not show myocardial recovery during VA-ECMO support could be directed to longterm ventricular assist device implantation or heart transplantation depending on age, general clinical and functional status, life expectancy and organs function (brain, lung, liver and kidneys). Finally, as stated by the European Society of Cardiology guidelines for the diagnosis and treatment of acute and chronic heart failure, short-term MCS should be considered (as a "bridge to recovery") in patients remaining severely hypoperfused despite inotropic therapy and with a potentially reversible cause (e.g., viral myocarditis) or a potentially ...

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Section: Introductionmentioning

confidence: 99%

Veno-arterial extracorporeal membrane oxygenation for cardiogenic shock due to myocarditis in adult patients

Pozzi¹,

Banfı²,

Grinberg³

et al. 2016

J. Thorac. Dis.

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“…[6][7][8][9] If the patient survives the acute phase, there may be normalization of cardiac function, making resumption of normal daily life possible. However, it is impossible to predict when patients with acute myocarditis may develop shock, with some patients developing cardiogenic shock a few days after hospitalization.…”

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confidence: 99%

Risk Factors for Patients Developing a Fulminant Course With Acute Myocarditis

Kato¹,

Morimoto²,

Hiramitsu³

et al. 2004

Circ J

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Background A fulminant course can be difficult to predict at the onset of acute myocarditis, so the aim of the present study was to identify the predictive clinical symptoms/signs or laboratory findings. Methods and Results Thirty-nine patients with acute lymphocytic myocarditis, excluding 8 who manifested shock at admission, were studied. The fulminant group was defined as 12 patients who developed shock after admission, requiring intraaortic balloon pumping or percutaneous cardiopulmonary support, and the non-fulminant group comprised the 27 patients without shock. Various parameters at admission were compared between the 2 groups, together with multiple logistic regression analysis, excluding 6 patients with partially missing values. In the fulminant group, C-reactive protein (7.0±7.0 vs 2.3±2.2 mg/dl, p<0.01) and creatine kinase (1,147±876 vs 594±568 IU/L, p<0.05) concentrations were higher, intraventricular conduction disturbances were more frequent (9/12 vs 7/27 patients, p<0.01) and the left ventricular ejection fraction was lower (40.7±13.9 vs 50.1±10.6%, p<0.05) than in the non-fulminant group. In the multiple logistic regression analysis model with the presence/absence of a fulminant course considered as the independent variable, and C-reactive protein, creatine kinase, intraventricular conduction disturbances, and left ventricular ejection fraction as dependent variables, a high-risk group (expected proportion of fulminant course ≥0.5) and a low-risk group (<0.5) could be differentiated. A fulminant course occurred in 9/13 (69%) patients in the high-risk group, but in only 2/20 (10%) patients in the low risk group (p<0.001). Conclusions The risk of a fulminant course of acute myocarditis was high in patients with elevated C-reactive protein, and creatine kinase concentrations, decreased left ventricular ejection fraction, and intraventricular conduction disturbances at the time of admission. (Circ J 2004; 68: 734 -739)

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“…PCPS is an accepted therapeutic device for selected patients with cardiogenic shock 1,2 accompanied by fulminant myocarditis, 3 acute massive myocardial infarction 4 or circu- latory insufficiency after open-heart surgery. 5,6 Alternate support from ventricular assist devices is necessary when cardiac function does not recover and powerful long-term assistance is needed.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous Cardiopulmonary Support Aids Resuscitation From Sustained Ventricular Tachycardia

Izawa

Katoh

Shiba

et al. 2003

Circ J

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he use of percutaneous cardiopulmonary support (PCPS) with intraaortic balloon pump (IABP) counterpulsation is an effective treatment for acute circulatory failure. We present a rare case of cardiogenic shock caused by sustained left ventricular tachycardia (LVT) and left ventricular apical dyskinesis, which was treated successfully with mechanical circulatory support system. It is sometimes difficult to uncover the immediate causes of life-threatening arrhythmia or LV dysfunction and using a mechanical circulatory support system can provide primary physicians with adequate time to successfully diagnose and treat reversible causes of cardiogenic shock. Case ReportA 67-year-old man was transferred to the intensive care unit (ICU) because of sustained LVT and cardiogenic shock. He had been well until the day of admission when he felt sudden intermittent chest discomfort and nausea. He had a history of hypertension and had been treated with nifedipine and diltiazem for 5 years. There were no symptoms attributable to infectious disease nor a personal or family history of cardiac disease.On arrival at the primary hospital, his blood pressure was 60/23 mmHg and his heart rate was 260 beats/min. Electrocardiography showed sustained monomorphic LVT with a QRS pattern of right-bundle branch block and a superior axis (Fig 1A,B). Medical termination was attempted initially because he was drowsy. The LVT did not respond to intravenous verapamil (10 mg) and lidocaine (100 mg), Circulation Journal Vol.67, December 2003so direct current cardioversion was performed; however, the LVT continued. Cardioversion was attempted several times after the intravenous administration of each of propranolol (2 mg), disopyramide (50 mg) and procainamide (600 mg). Brief episodes of asystole occurred, followed by LVT. Temporary right ventricular pacing was initiated. Coronary angiography showed normal coronary arteries. The patient had to undergo cardiopulmonary resuscitation during transfer to the ICU at our hospital.Upon arrival in the ICU, the patient's cardiac rhythm alternated between LVT and cardiac standstill with ventricular pacing. His lungs were clear and no murmur or extra heart sounds were heard. Chest X-ray was normal. Two-dimensional echocardiography showed diffuse left ventricular (LV) hypokinesis and dyskinesis of the apical wall (Fig 2). His white blood cell count was 17,910/mm 3 , serum creatine kinase was 410 IU/L, magnesium was 2.2 mg/dl, and C-reactive protein was 0.07 mg/dl. PCPS (CAPIOX SX custom pack, Terumo, Tokyo, Japan) was begun immediately through the right femoral artery and vein with extracorporal circulatory support at 3.0 L/min. Under circulatory support, we performed a right ventricular endomyocardial biopsy and found normal myocardium. The IABP was subsequently inserted through the left femoral artery and was set to 1:1 assistance. Anticoagulation therapy was intravenous administration of heparin to achieve an activated coagulation time of 200 s. After these procedures, the patient's hemodynamic status had imp...

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Use of percutaneous cardiopulmonary support of patients with fulminant myocarditis and cardiogenic shock for improving prognosis

Cited by 61 publications

References 8 publications

Veno-arterial extracorporeal membrane oxygenation for cardiogenic shock due to myocarditis in adult patients

Veno-arterial extracorporeal membrane oxygenation for cardiogenic shock due to myocarditis in adult patients

Risk Factors for Patients Developing a Fulminant Course With Acute Myocarditis

Percutaneous Cardiopulmonary Support Aids Resuscitation From Sustained Ventricular Tachycardia

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