Pediatric Acute Myocarditis With Short-Term Outcomes and Factors for Extracorporeal Membrane Oxygenation: A Single-Center Retrospective Cohort Study in Vietnam

Abstract

Objective: Data on the management and outcomes of acute myocarditis treated with extracorporeal membrane oxygenation (ECMO) among low- and middle-income countries are limited. This study aimed to determine the short-term outcomes and also identify factors associated with ECMO use among children with acute myocarditis at a tertiary children's hospital in Vietnam.Methods: A single-center, retrospective observational study was conducted between January 2016 and February 2021. Pediatric patients with acute myocarditis, aged 1 month to 16 years, were included.Results: In total, 54 patients (male, 46%; median age, 7 years) with acute myocarditis were included; 37 of them received ECMO support. Thirty percent (16/54) of the patients died, and 12 of them received ECMO. Laboratory variables that differed between survivors and non-survivors included median left ventricular ejection fraction (LVEF) at 48 h (42 vs. 25%; p = 0.001), platelet count (304 g/L [interquartile range (IQR): 243–271] vs. 219 g/L [IQR: 167–297]; p = 0.014), and protein (60 g/dl [IQR: 54–69] vs. 55 [IQR: 50–58]; p = 0.025). Among patients who received ECMO, compared with the survivors, non-survivors had a low LVEF at 48 h (odds ratio (OR), 0.8; 95% confidence interval (CI): 0.6–0.9; p = 0.006) and high vasoactive-inotropic score (OR, 1.0; 95% CI: 1.0–1.0; p = 0.038) and lactate (OR, 2.8; 95% CI, 1.2–6.1; p = 0.013) at 24 h post-ECMO.Conclusions: The case fatality rate among children with acute myocarditis was 30 and 32% among patients requiring ECMO support. Arrhythmia was an indicator for ECMO in patients with cardiogenic shock.

Short‐Term Mortality Among Pediatric Patients With Heart Diseases Undergoing Veno‐Arterial Extracorporeal Membrane Oxygenation: A Systematic Review and Meta‐Analysis

“…We further excluded 42 studies after full‐text evaluation, because they did not meet inclusion criteria. Eventually, 28 studies 11 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 were amenable to meta‐analysis (Figure 1 ).…”

“…In our meta‐analysis, applying a random‐effects model, the pooled short‐term mortality (28 studies,1736 patients) was 45.6% (95% CI, 38.7%–52.4%) (Figure 2 ). 11 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 There was no evidence for publication bias because of the funnel plot appearing visually symmetrical (Figure 3 ), and the Egger test suggesting insignificant difference for our primary outcome of interest ( P egger =0.23). The sensitivity analysis performed by excluding the studies with a Joanna Briggs Institute score <8, showed that the pooled short‐term mortality was 46.2% (95% CI, 39.0%–53.4%).…”

“…After excluding 5 studies that included a few patients with arrhythmias, cardiomyopathy, and others, we found a short‐term mortality of 48.9% (95% CI, 42.3%–55.6%) (Figure S1 ). 19 , 20 , 21 , 22 , 23 , 24 , 26 , 27 , 28 , 29 , 31 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 Removing studies reporting 30‐day mortality, the pooled mortality was 45.4% (95% CI, 37.9%–52.9%) (Figure S2 ). 11 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 29 , 30 , 31 , 32 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 45 The similar short‐term mortality ind...…”

“… 19 , 20 , 21 , 22 , 23 , 24 , 26 , 27 , 28 , 29 , 31 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 Removing studies reporting 30‐day mortality, the pooled mortality was 45.4% (95% CI, 37.9%–52.9%) (Figure S2 ). 11 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 29 , 30 , 31 , 32 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 45 The similar short‐term mortality indicated that the estimated primary outcome was consistent. Additionally, a leave‐1‐out sensitivity analysis revealed that no individual study significantly changed the pooled short‐term mortality, indicating the results remained stable (Figure…”

“…Additionally, a leave‐1‐out sensitivity analysis revealed that no individual study significantly changed the pooled short‐term mortality, indicating the results remained stable (Figure S3 ). 11 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 The main results of the meta‐analysis are presented in Table 1 . Furthermore, the overall proportions exhibited similarity to the average rates obtained through simple pooling (Table S5 ), suggesting the robustness of the findings despite significant heterogeneity.…”