Experience and result of extracorporeal membrane oxygenation in treating fulminant myocarditis with shock: what mechanical support should be considered first?
BACKGROUND
Extracorporeal membrane oxygenation (ECMO), instead of ventricular assist device (VAD), could work as the first-line treatment of choice for fulminant myocarditis (FM) with profound shock if intraaortic balloon pumping was inadequate. We reviewed our experience in treating FM with ECMO and compared it with the literature that described the use of VAD.


METHODS
Fifteen consecutive patients (age 27.1 +/- 19.3 years) who had FM with profound shock were rescued with ECMO emergently. Hypotension, depressed left ventricular ejection fraction (19.1% +/- 6.1%), and oliguria occurred in all patients with high-dose catecholamine (inotropic equivalents: 69.0 +/- 37.7 microg/kg/min) and ventilator support. Before ECMO support, 6 patients received intraaortic balloon pumping support, 5 received external cardiac massage, 5 needed a temporary pacemaker, and 4 needed continuous hemofiltration. The pre-ECMO cardiac enzyme and liver enzyme levels were abnormally high.


RESULTS
Fourteen patients (93.3%) could be weaned off mechanical support. Three of 14 successfully weaned patients died later as a result of complications. Survival to discharge was 73.3%, and none of survivors needed heart transplantation. The ECMO duration was 137.7 +/- 74.5 hours. The ECMO-related neurological complication (6.7%) and the reexploration rate for hemostasis (8.9%) were lower than the myocarditis group supported by VAD from the literature review. The 11 survivors exhibited no cardiac dysfunction during the follow-up period.


CONCLUSIONS
Owning to advantages of fewer complications, easier application, and biventricular support, ECMO can be considered as the first-line treatment of mechanical support for FM with profound shock when intraaortic balloon pumping is inadequate or infeasible.
Chen
Yih-Sharng
YS
Department of Cardiovascular Surgery, National Taiwan University Hospital, 7 Chung-Shan S Road, Taipei 100, Taiwan.
Yu
Hsi-Yu
HY
Huang
Shu-Chien
SC
Chiu
Kaung-Ming
KM
Lin
Tzu-Yu
TY
Lai
Lin-Ping
LP
Lin
Fang-Yue
FY
Wang
Shoei-Shan
SS
Chu
Shu-Hsun
SH
Ko
Wen-Je
WJ
D000328:Adult; D000368:Aged; D001219:Aspartate Aminotransferases / Q000378:metabolism; D015415:Biomarkers / Q000097:blood; D002648:Child; D052279:Creatine Kinase, MB Form / Q000378:metabolism; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000378:metabolism; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy*; D014336:Troponin / Q000378:metabolism
D015415:Biomarkers; D014336:Troponin; D001219:Aspartate Aminotransferases; D052279:Creatine Kinase, MB Form