Impact of Extracorporeal Membrane Oxygenation on Acute Fulminant Myocarditis-related Hemodynamic Compromise Arrhythmia in Children

Lin, Kuo-Jen; Li, Ming-Hsiu; Hsieh, Kai‐Sheng; Kuo, Hsuan-Chang; Cheng, Ming-Chou; Sheu, Jiunn‐Jye; Lin, Ying-Jui

doi:10.1016/j.pedneo.2016.02.002

Cited by 32 publications

(25 citation statements)

References 25 publications

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“…[15] In a study on children with acute fulminant myocarditis, the overall patient survival rate was 78% (14/18), and three of the four nonsurviving patients died of VT and heart failure refractory to medical treatment. [19]…”

Section: Discussionmentioning

confidence: 99%

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A Risk Prediction Model for In-hospital Mortality in Patients with Suspected Myocarditis

Zhao

Gao

et al. 2017

Chinese Medical Journal

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Background:Myocarditis is an inflammatory disease of the myocardium that may lead to cardiac death in some patients. However, little is known about the predictors of in-hospital mortality in patients with suspected myocarditis. Thus, the aim of this study was to identify the independent risk factors for in-hospital mortality in patients with suspected myocarditis by establishing a risk prediction model.Methods:A retrospective study was performed to analyze the clinical medical records of 403 consecutive patients with suspected myocarditis who were admitted to Ningbo First Hospital between January 2003 and December 2013. A total of 238 males (59%) and 165 females (41%) were enrolled in this study. We divided the above patients into two subgroups (survival and nonsurvival), according to their clinical in-hospital outcomes. To maximize the effectiveness of the prediction model, we first identified the potential risk factors for in-hospital mortality among patients with suspected myocarditis, based on data pertaining to previously established risk factors and basic patient characteristics. We subsequently established a regression model for predicting in-hospital mortality using univariate and multivariate logistic regression analyses. Finally, we identified the independent risk factors for in-hospital mortality using our risk prediction model.Results:The following prediction model for in-hospital mortality in patients with suspected myocarditis, including creatinine clearance rate (Ccr), age, ventricular tachycardia (VT), New York Heart Association (NYHA) classification, gender and cardiac troponin T (cTnT), was established in the study: P = ea/(1 + ea) (where e is the exponential function, P is the probability of in-hospital death, and a = −7.34 + 2.99 × [Ccr <60 ml/min = 1, Ccr ≥60 ml/min = 0] + 2.01 × [age ≥50 years = 1, age <50 years = 0] + 1.93 × [VT = 1, no VT = 0] + 1.39 × [NYHA ≥3 = 1, NYHA <3 = 0] + 1.25 × [male = 1, female = 0] + 1.13 × [cTnT ≥50 μg/L = 1, cTnT <50 μg/L = 0]). The area under the receiver operating characteristic curve was 0.96 (standard error = 0.015, 95% confidence interval [CI]: 0.93-0.99). The model demonstrated that a Ccr <60 ml/min (odds ratio [OR] = 19.94, 95% CI: 5.66–70.26), an age ≥50 years (OR = 7.43, 95% CI: 2.18–25.34), VT (OR = 6.89, 95% CI: 1.86–25.44), a NYHA classification ≥3 (OR = 4.03, 95% CI: 1.13–14.32), male gender (OR = 3.48, 95% CI: 0.99–12.20), and a cTnT level ≥50 μg/L (OR = 3.10, 95% CI: 0.91–10.62) were the independent risk factors for in-hospital mortality.Conclusions:A Ccr <60 ml/min, an age ≥50 years, VT, an NYHA classification ≥3, male gender, and a cTnT level ≥50 μg/L were the independent risk factors resulting from the prediction model for in-hospital mortality in patients with suspected myocarditis. In addition, sufficient life support during the early stage of the disease might improve the prognoses of patients with suspected myocarditis with multiple risk factors for in-hospital mortality.

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Section: Discussionmentioning

confidence: 99%

“…A study on acute fulminant myocarditis in children revealed that timely use of extracorporeal membrane oxygenation (ECMO) can improve survival rates. [19] Our hospital does not have ECMO equipment. Finally, the validity of a prediction model should be verified by external data.…”

Section: Discussionmentioning

confidence: 99%

A Risk Prediction Model for In-hospital Mortality in Patients with Suspected Myocarditis

Zhao

Gao

et al. 2017

Chinese Medical Journal

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“…Two studies were published regarding ECMO in fulminant myocarditis . The first is a review of 8 cases of fulminant myocarditis requiring ECMO in children with a median age of 8 years .…”

Section: Discussionmentioning

confidence: 99%

“…Longer duration of ECMO support was associated with decreased survival. The second study is a retrospective review of 18 cases of fulminant myocarditis of which 16 (89%) had an arrhythmia at presentation . Seven children were supported with ECMO, and all survived.…”

Section: Discussionmentioning

confidence: 99%

What is new in pediatric ECMO? 2016, a year in review

Roeleveld

2017

European J of Heart Fail

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With the increasing use of extracorporeal membrane oxygenation in children come increasing publications concerning pediatric ECMO. In 2016 important work was done in identifying modifiable risk-factors and possible predictors of mortality in cardiac and respiratory ECMO and risk-estimation scores have been developed for respiratory ECMO patients. Also, increasing important experience is published in the areas of neurodevelopmental follow-up of ECMO survivors. The most relevant publications of 2016 are summarized in this review.

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“…VA ECMO may be ideal in the setting of refractory ventricular arrhythmias. If it is impossible to terminate or control severe ventricular arrhythmias, placing the patient on VA ECMO is a relatively simple solution, as long as there is a path forward (such as ablation or definitive therapy such as a heart transplant or a total artificial heart placement) [ 23 – 26 ]. One issue to consider is whether the ventricles will eject in the setting of refractory arrhythmias.…”

Section: Who Is a Candidate For Ecmomentioning

confidence: 99%

Extracorporeal Membrane Oxygenation (ECMO) and the Critical Cardiac Patient

Baran

2017

Curr Transpl Rep

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Purpose of ReviewThis review is to summarize the basics of veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) as it is utilized for critically ill cardiac patients.Recent FindingsECMO may be instituted in a variety of health care settings, from the emergency room to the operating room. The types of patients who may benefit from ECMO are reviewed in detail. The complications of ECMO are reviewed, including access-related issues and hematologic and neurologic problems. The principles of weaning of ECMO are described.ConclusionDue to its versatility and relatively low cost, VA ECMO use is sharply increasing worldwide. It is important to select patients carefully for this mode of therapy as it can keep patients alive even in states of severe neurologic impairment or multiorgan failure. Short courses of ECMO may allow critically ill patients to be salvaged, but ultimately survival depends on resolution of the underlying problem or ability to transition to another more durable mode of cardiac support.

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Impact of Extracorporeal Membrane Oxygenation on Acute Fulminant Myocarditis-related Hemodynamic Compromise Arrhythmia in Children

Cited by 32 publications

References 25 publications

A Risk Prediction Model for In-hospital Mortality in Patients with Suspected Myocarditis

A Risk Prediction Model for In-hospital Mortality in Patients with Suspected Myocarditis

What is new in pediatric ECMO? 2016, a year in review

Extracorporeal Membrane Oxygenation (ECMO) and the Critical Cardiac Patient

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