Extracorporeal membranous oxygenation support for acute fulminant myocarditis: analysis of a single center's experience☆

Abstract

AFM still carries high mortality rates in spite of advanced mechanical support. Most of the survivors did not require transplantation and could return to good lifestyle. Due to its simplicity and effectiveness, ECMO can be a first-line tool to rescue this group of patients.

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

“…In our series, cerebral events and acute renal failure were the most frequent complications, as again shown by Diddle and associates in the ELSO Registry [6], followed by bleeding, multiorgan failure, sepsis, and renal failure that required dialysis (Table 3). We observed a lower incidence of renal replacement therapy, bleeding, and sepsis than other series [9,10,11,13], whereas lower extremity ischemia and neurologic injuries were similar to the data of other investigators [9,10]. Note that almost one-fourth of our patients had evidence of LV distension that required ventricular venting, in accordance with the rate reported by Hsu and colleagues [10].…”

“…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.…”