Survival of neonates with enteroviral myocarditis requiring extracorporeal membrane oxygenation.
OBJECTIVE
Neonates infected with enteroviruses may present with severe myocarditis and medically refractory cardiopulmonary collapse. Extracorporeal membrane oxygenation (ECMO) has been used to support patients in this setting, but its efficacy has not been systematically studied. We sought to review the Extracorporeal Life Support Organization registry to determine survival rates and identify predictors of in hospital mortality for these neonates.


METHODS
Retrospective cohort study using data reported to the Extracorporeal Life Support Organization registry.


METHODS
Multi-institutional data.


METHODS
Patients ≤ 15 days old with enteroviral myocarditis who required ECMO support between 2000 and 2008.


METHODS
None.


RESULTS
Twenty-four neonates with enteroviral myocarditis were reported to the Extracorporeal Life Support Organization registry during the study period. The survival to hospital discharge rate was 33% (n = 8). Multisystem organ dysfunction was more common in nonsurvivors than in survivors (75% vs. 0%, p < .01). In particular, nonsurvivors had a higher prevalence of renal dysfunction (50% vs. 0%, p = .02). Nonsurvivors also had a greater number of ECMO-related complications (5 vs. 3.5, p = .03).


CONCLUSIONS
Cardiopulmonary support with ECMO should be considered for neonates with severe enteroviral myocarditis that fails conventional medical therapies. Multisystem organ dysfunction, particularly with renal involvement, may portend a poor prognosis and is one of several factors that should be considered in the decision to initiate and/or continue mechanical support for these patients.
Madden
Kate
K
Department of Anesthesia, Children's Hospital Boston, Boston, MA, USA.
Thiagarajan
Ravi R
RR
Rycus
Peter T
PT
Rajagopal
Satish K
SK
D015331:Cohort Studies; D004770:Enterovirus / Q000302:isolation & purification*; D004769:Enterovirus Infections / Q000401:mortality*; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D009205:Myocarditis / Q000401:mortality*; D009656:North America / Q000453:epidemiology; D012042:Registries; D012189:Retrospective Studies; D016019:Survival Analysis