Management and Outcomes in Pediatric Patients Presenting with Acute Fulminant Myocarditis

Teele, Sarah A.; Allan, Catherine K.; Laussen, Peter C.; Newburger, Jane W.; Gauvreau, Kimberlee; Thiagarajan, Ravi R.

doi:10.1016/j.jpeds.2010.10.015

Cited by 118 publications

(71 citation statements)

References 25 publications

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“…In a study of pediatric acute myocarditis admissions in 42 American tertiary care hospitals from 2006 to 2011 128 ( Figure 3), >70% of the patients received IVIG. A 2005 meta-analysis of the use of IVIG for acute myocarditis in children or adults 132,133 could not find enough evidence to recommend its routine use for acute myocarditis. Furthermore, a benefit of IVIG therapy cannot be discerned in recent single-center 80 and multicenter 43,77 outcome studies of pediatric myocarditis.…”

Section: January 7 2014mentioning

confidence: 99%

Diagnosis and Treatment of Myocarditis in Children in the Current Era

2014

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Section: January 7 2014mentioning

confidence: 99%

Diagnosis and Treatment of Myocarditis in Children in the Current Era

2014

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“…Previous pediatric reports report overall mortality rates in myocarditis of ≈15%, and patients with fulminant myocarditis and those requiring mechanical cardiovascular support have worse outcomes. 8,10,13,14 Multiple reasons may account for the relatively low mortality in this study. We analyzed all patients in the PHIS database with the diagnosis of acute myocarditis, irrespective of morbidity, and our mortality analysis is limited to a single hospitalization.…”

Section: Discussionmentioning

confidence: 86%

Demographics, Trends, and Outcomes in Pediatric Acute Myocarditis in the United States, 2006 to 2011

Ghelani

Spaeder

Pastor

et al. 2012

Circ: Cardiovascular Quality and Outcomes

164

154

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Background— There is a lack of clear diagnostic and management guidelines for acute myocarditis in the pediatric population. We used a multi-institutional database to characterize demographics, practice variability, and outcomes in this population. Methods and Results— Patients with acute myocarditis (n=514) were identified from April 2006 to March 2011 using the Pediatric Health Information System database, and regional variations in management and outcomes were analyzed. Ninety-seven patients (18.9%) received extracorporeal membrane oxygenation, 22 (4.3%) received ventricular assist device, 21 (4.1%) received heart transplantation, and 37 (7.2%) died. Of the 104 patients who received extracorporeal membrane oxygenation or ventricular assist device, 17 (16.3%) had heart transplantation, 25 (24%) died, and 62 (59.6%) showed recovery of myocardial function. There was a decrease in the use of endomyocardial biopsy ( P =0.03) and an increase in the use of magnetic resonance imaging ( P <0.01) over the study period. Although the use of medications and procedures varied between different regions, the occurrence of death or heart transplantation showed no significant regional associations. The use of extracorporeal membrane oxygenation (odds ratio, 5.8; 95% confidence interval, 2.9–11.4; P <0.01), ventricular assist device (odds ratio, 8.2; 95% confidence interval, 2.7–24.9; P <0.01), and vasoactive medications (odds ratio, 5.7; 95% confidence interval, 1.2–26.1; P =0.03) was independently associated with death/transplantation. Conclusions— There is significant temporal and regional variation in the diagnostic modalities and management used for pediatric myocarditis, which continues to have high morbidity and mortality. Extracorporeal membrane oxygenation, ventricular assist device, and vasoactive medications are independently associated with increased mortality/transplantation.

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“…[11] Previous studies have reported promising outcomes from neonatal ECMO service for AFM with an overall survival and discharge rate reaching 62.5-71%. [11,[16][17][18][19] In our series, AFM was the prevalent etiology of APCPF. The results of our study demonstrated a 100% success rate of cure and discharge for this patient population.…”

Section: Discussionmentioning

confidence: 53%

Impact of Extracorporeal Membrane Oxygenation Support on Clinical Outcome of Pediatric Patients with Acute Cardiopulmonary Failure: A Single-Center Experience

Lin¹,

Chung²,

Liang³

et al. 2013

Biomed J

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Background: Conventional therapy against acute pediatric cardiopulmonary failure (APCPF) caused by a variety of disease entities remains unsatisfactory with extremely high morbidity and mortality. For refractory APCPF, extracorporeal membrane oxygenation (ECMO) is one of the last resorts. Methods:In this study, the in-hospital outcomes of pediatric patients with refractory APCPF receiving ECMO support were reviewed. Results:Between August 2006 and May 2011, a single-center cohort study was performed in pediatric patients who required ECMO support due to cardiogenic shock or severe hypoxemia. A total of 22 patients with mean age of 7.0 ± 6.3 years received ECMO (male = 11; female = 11). The indications included acute fulminant myocarditis (AFM) (n = 6), congenital diaphragmatic hernia (CDH) (n = 3), acute respiratory distress syndrome (ARDS) (n = 6), enterovirus 71 (n = 3), viral sepsis (n = 2), refractory ventricular fibrillation due to long QT syndrome (n = 1), and pulmonary edema with brain herniation (n = 1). Eighteen patients received veno-arterial (VA) mode ECMO, while another four patients undertook the veno-venous (VV) mode. The duration of ECMO use and hospitalization were 6.1 ± 3.1 and 24.4 ± 19.4 days, respectively. The survival rate in patients with AFM was 100% (n = 6). Successful ECMO weaning with uneventful discharge from hospital was noted in 14 (63.6%) patients, whereas in-hospital mortality despite successful ECMO weaning occurred in 5 patients (22.7%). Failure in ECMO weaning and in-hospital death was noted in 3 patients (13.6%). Conclusions: ECMO resuscitation is an effective strategy in the clinical setting of APCPF. (Biomed J 2013;36:28-34)

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Management and Outcomes in Pediatric Patients Presenting with Acute Fulminant Myocarditis

Cited by 118 publications

References 25 publications

Diagnosis and Treatment of Myocarditis in Children in the Current Era

Diagnosis and Treatment of Myocarditis in Children in the Current Era

Demographics, Trends, and Outcomes in Pediatric Acute Myocarditis in the United States, 2006 to 2011

Impact of Extracorporeal Membrane Oxygenation Support on Clinical Outcome of Pediatric Patients with Acute Cardiopulmonary Failure: A Single-Center Experience

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