Favourable clinical outcome in patients with cardiogenic shock due to fulminant myocarditis supported by percutaneous extracorporeal membrane oxygenation

Abstract

In patients with fulminant myocarditis, percutaneous ECMO is a highly effective form of a haemodynamic support. Once a patient recovers from inflammatory myocardial damage, the subsequent clinical outcome is favourable, similar to that observed in patients with acute non-fulminant myocarditis.

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

“…The cause of acute myocarditis often remains undetermined, but investigations have indicated that viruses represent the most frequent agent [1-3, 14, 15]. Endomyocardial biopsy is considered the gold standard diagnostic tool, although this procedure remains largely underused and has shown low negative predictive value [1,2,13,15]. In our series, one-fourth of the patients had endomyocardial biopsy performed, and acute myocarditis was confirmed in all patients.…”

“…The clinical scenario of AFM may be characterized by a self-limiting form with rather rapid cardiac recovery and excellent early and mid-term prognosis [1,2,13,15]. 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].…”

“…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].…”

“…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.…”