Extracorporeal Membrane Oxygenation for Fulminant Myocarditis: Increase of Cardiac Enzyme and SOFA Score Is Associated with High Mortality

Abstract

We aimed to evaluate the outcomes of patients with fulminant myocarditis and investigate the factors associated with mortality. This is a retrospective single-center cohort study that included adult and pediatric patients with fulminant myocarditis treated at Samsung Medical Center between September 2004 and December 2019. The primary outcome was in-hospital mortality. Among 100 patients, 71 underwent veno-arterial extracorporeal membrane oxygenation (ECMO) (ECMO group). Comorbidities were not significantly different between the ECMO and non-ECMO groups. Cardiac enzymes, creatinine, and median sequential organ failure assessment (SOFA) score at intensive care unit admission were significantly different between the groups. Twenty patients (28.7%) in the ECMO group and two (6.9%) in the non-ECMO group died in-hospital (p = 0.02). The significant risk factors of in-hospital mortality were creatine kinase MB fraction (CK-MB) and SOFA score (p = 0.009 and p = 0.001, respectively) in the ECMO group. In the receiver-operating characteristic curve analysis, the cutoffs of SOFA score and CK-MB were 12 and 94.74 ng/mL, respectively. The patients with both variables above the cutoffs showed significantly worse outcomes (p < 0.001). ECMO can be an effective treatment option for fulminant myocarditis. SOFA score and CK-MB are significant risk factors for in-hospital mortality.

Extracorporeal Membrane Oxygenation for the Support of Adults with Acute Myocarditis

“…The most important clinical predictor is the prolonged prevalence of arrhythmias be they atrioventricular block or ventricular arrhythmias [27]. SOFA score has also been associated with the patient outcome with scores >12 shown to be predictive of death or established heart failure [28]. CK-MB is the most well-reported biomarker with two independent studies agreeing to its prognostic value with levels >95 ng/mL [28] or > 185 IU/L [27] predicting a lower chance of successful weaning.…”

Veno-Arterial Extracorporeal Membrane Oxygenation in Patients with Fulminant Myocarditis: A Review of Contemporary Literature

“…These studies are summarized in Table 2. Most recently, Lee et al [60] analyzed risk factors in pediatric patients diagnosed with fulminant myocarditis treated with VA-ECMO. They showed that among 71 patients who underwent ECMO, use of creatinine kinase-MB (CK-MB) with a cut-off of 94.74 ng/mL and a SOFA score with a cut-off score of 12 accurately predicted mortality.…”

Influence of confirmed viral infection on adult acute fulminant myocarditis supported with extracorporeal membrane oxygenation

“…6 Venoarterial extracorporeal membrane oxygenation (VA-ECMO) has been proven to be an effective support method for AFM with cardiogenic shock. 6 Many studies have identified prognostic factors and risk factors for fulminant myocarditis supported by ECMO. [6][7][8][9] The additional use of renal replacement therapy (RRT) or mechanical ventilation during ECMO is a common strategy for preventing kidney dysfunction, fluid and electrolyte imbalance and promoting recovery.…”

“…6 Many studies have identified prognostic factors and risk factors for fulminant myocarditis supported by ECMO. [6][7][8][9] The additional use of renal replacement therapy (RRT) or mechanical ventilation during ECMO is a common strategy for preventing kidney dysfunction, fluid and electrolyte imbalance and promoting recovery. However, it is unclear if RRT use during ECMO support and different ventilator settings in positive end-expiratory pressure (PEEP) influence mortality in adult patients with AFM receiving ECMO.…”

“…Acute fulminant myocarditis (AFM) is a rapidly progressive life‐threatening disease accompanied by hemodynamic instability, decompensated heart failure, and cardiogenic shock 6 . Venoarterial extracorporeal membrane oxygenation (VA‐ECMO) has been proven to be an effective support method for AFM with cardiogenic shock 6 . Many studies have identified prognostic factors and risk factors for fulminant myocarditis supported by ECMO 6–9 .…”