Recommendations for weaning off cardiopulmonary support in children with fulminant myocarditis.
BACKGROUND
The purpose of this study was to determine the appropriate recommendations for weaning off cardiopulmonary support (CPS) in children with fulminant myocarditis.


RESULTS
Four consecutive patients diagnosed with fulminant myocarditis who were treated with CPS were enrolled (mean age: 9 years). The relationships between timing of weaning from CPS and various factors, including bleeding episodes, platelet count, serum concentration of the MB isoform of creatine kinase (CK-MB), echocardiographic findings, and the mixed venous blood oxygen saturation (SvO2), were retrospectively analyzed. All patients had CPS performed safely for a mean duration of 53.1 h without exchange of the circuit. Three of the 4 patients had a bleeding episode before discontinuation. The minimum platelet count occurred during weaning in all 4 patients. The peak serum CK-MB concentration when initiating CPS was higher than the peak value on the day of weaning. Echocardiographic findings before stopping CPS were similar to those after weaning. The SvO2 was 62.5% when initiating CPS and 71.3% before weaning.


CONCLUSIONS
In children with fulminant myocarditis CPS can be used without exchanging the circuit and can be discontinued before bleeding episodes become symptomatic, with improvement in the biomarkers and SvO2 on weaning off CPS.
Kanamaru
Hiroshi
H
Department of Pediatrics and Childhealth, Nihon University School of Medicine, Itabashi-ku, Tokyo 173-8610, Japan. hkin@med.nihon-u.ac.jp
Karasawa
Kensuke
K
Abe
Osamu
O
Miyashita
Michio
M
Ayusawa
Mamoru
M
Sumitomo
Naokata
N
Okada
Tomoo
T
Harada
Kensuke
K
Mugishima
Hideo
H
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D052279:Creatine Kinase, MB Form / Q000378:metabolism; D004562:Electrocardiography; D005260:Female; D006287:Health Planning Guidelines; D006470:Hemorrhage / Q000503:physiopathology; D006801:Humans; D008297:Male; D009205:Myocarditis / Q000503:physiopathology* / Q000628:therapy*; D010100:Oxygen / Q000097:blood; D010976:Platelet Count; D012121:Respiration, Artificial; D012189:Retrospective Studies; D013997:Time Factors; D015300:Ventilator Weaning / Q000379:methods*
D052279:Creatine Kinase, MB Form; D010100:Oxygen