Prognostic factors in children with acute fulminant myocarditis receiving venoarterial extracorporeal membrane oxygenation

Abstract

BackgroundPediatric acute fulminant myocarditis (AFM) is a very dangerous disease that may lead to acute heart failure or even sudden death. Previous reports have identified some prognostic factors in adult AFM; however, there is no such research on children with AFM on venoarterial extracorporeal membrane oxygenation (VA-ECMO). This study aimed to find relevant prognostic factors for predicting adverse clinical outcomes.MethodsA retrospective analysis was performed in an affiliated university children’s hospital with consecutive patients receiving VA-ECMO for AFM from July 2010 to November 2020. These children were classified into a survivor group (n=33) and a non-survivor group (n=8). Patient demographics, clinical events, laboratory findings, and electrocardiographic and echocardiographic parameters were analyzed.ResultsPeak serum creatinine (SCr) and peak creatine kinase isoenzyme MB during ECMO had joint predictive value for in-hospital mortality (p=0.011, AUC=0.962). Based on multivariable logistic regression analysis, peak SCr level during ECMO support was an independent predictor of in-hospital mortality (OR=1.035, 95% CI 1.006 to 1.064, p=0.017, AUC=0.936, with optimal cut-off value of 78 μmol/L).ConclusionTissue hypoperfusion and consequent end-organ damage ultimately hampered the outcomes. The need for left atrial decompression indicated a sicker patient on ECMO and introduced additional risk for complications. Earlier and more cautious deployment would likely be associated with decreased risk of complications and mortality.

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.…”