Efficacy of central extracorporeal life support for patients with fulminant myocarditis and cardiogenic shock

Abstract

OBJECTIVES Fulminant myocarditis with cardiogenic shock requires extracorporeal life support (ECLS) and has poor outcomes. To improve outcomes, we have converted patients with severely impaired cardiac and multiorgan function from peripheral to central ECLS. In this study, we reviewed these patients’ clinical outcomes and investigated associated factors. METHODS We retrospectively studied 70 consecutive patients with fulminant myocarditis under peripheral support from 2006 to 2020. Forty-eight patients underwent surgical conversion to central support, and the remaining patients continued peripheral support. The end point was survival and ventricular assist device-free survival. RESULTS More severe pulmonary congestion and multiorgan failure were present in patients with central than peripheral support. Weaning from ECLS was achieved in 95% and 62% of patients with peripheral and central support, respectively. Five-year survival was not significantly different between patients with central and peripheral support (71.2% vs 87.5%, respectively; P = 0.15). However, the ventricular assist device-free survival rate was significantly higher in patients with central than peripheral support (82.2% vs 52.0%, respectively; P = 0.017). A peak creatine kinase-MB level of >180 IU/l, rhythm disturbance and aortic valve closure were detrimental to functional recovery in patients with central support. CONCLUSIONS Conversion to central ECLS is feasible and safe in patients with fulminant myocarditis. Patients with severe myocardial injury as shown by a high creatine kinase-MB level, rhythm disturbance and aortic valve closure should be converted to a durable left ventricular assist device.

Research focus and theme trend on fulminant myocarditis: A bibliometric analysis

“…The co-occurrence of keywords was analyzed to understand the research content better. The results indicate that there were four main topics in the area of FM: (I) Concentrate on the application of mechanical circulatory support to patients diagnosed with FM, especially for those with cardiogenic shock ( 55 , 56 ). In addition, children with FM have been paid much attention to ( 57 , 58 ).…”

Prognostic impact of lung computed tomography density in cardiogenic shock patients with veno‐arterial extracorporeal membrane oxygenation

“…14,15 The last reason is that our policy for MCS escalation has been updated recently and tailored to the condition of each patient. [16][17][18][19] For these reasons, our study population appeared to have a better survival rate. However, there is still room for improved patient management before MCS escalation, and our study provides important evidence for improving this management.…”

“…Second, our patient population included 31 (47.7%) patients with myocarditis, which is a distinctive etiology with favorable outcomes (60% 30‐day or in‐hospital survival), even if they temporarily required ECMO support 14,15 . The last reason is that our policy for MCS escalation has been updated recently and tailored to the condition of each patient 16–19 . For these reasons, our study population appeared to have a better survival rate.…”

Extracorporeal Membrane Oxygenation for the Support of Adults with Acute Myocarditis

“…Their main use in fulminant myocarditis is as bridge-to-recovery, bridge-to-transplant or bridge-to-bridge (bridge to a more permanent solution such as a durable VAD) in irreversible conditions often as a result of giant cell myocarditis. ECMO efficacy in fulminant myocarditis has been well described with survival rates of around 75% and VAD-free survival rates of around 61% [22,23].…”