title: Clinical outcomes in fulminant myocarditis requiring extracorporeal membrane oxygenation: a weighted meta-analysis of 170 patients.
abstract: BACKGROUND
  Fulminant myocarditis (FM) is often a self-resolving entity if the patient survives the acute illness. Venoarterial extracorporeal membrane oxygenation (ECMO) has been used successfully for treatment of cardiogenic shock or cardiac arrest due to FM. However, clinical outcomes are not well understood, in part because of small study sizes. In the absence of large clinical trials, performance of pooled analysis represents the best method for ascertaining survival rates for ECMO.
  
  
  METHODS
  A systematic Medline search was conducted on ECMO for the treatment of FM, updated up to November 2012. Studies with n ≥10 published in the year 2000 or later that reported survival to hospital discharge for FM requiring ECMO were included. Studies that reported only on pediatric patients were excluded. The smaller of studies with overlapping patients were excluded. Cochran Q and I(2) were calculated and reported.
  
  
  RESULTS
  Six studies were included in the analysis, encompassing 170 patients. The minimum and maximum reported rates of survival to hospital discharge were 60.0% and 87.5%, respectively. The cumulative rate was 115/170. The calculated Cochran Q value was 3.63, which was not significant for heterogeneity. The I(2) value was 0%. The pooled estimate rate was 66.9% with a 95% confidence interval of 59.4%-73.7%.
  
  
  CONCLUSIONS
  More than two-thirds of patients with FM and either cardiogenic shock and/or cardiac arrest survive to hospital discharge with ECMO. These findings could be used in the risk-benefit analysis when initiation of a cardiopulmonary bypass system is being considered for FM.
authors.affiliation: Cedars-Sinai Heart Institute, Los Angeles, California.
authors.forename: Richard
authors.initials: R
authors.lastname: Cheng
authors.affiliation: Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Rory
authors.initials: R
authors.lastname: Hachamovitch
authors.affiliation: Cedars-Sinai Heart Institute, Los Angeles, California.
authors.forename: Michelle
authors.initials: M
authors.lastname: Kittleson
authors.affiliation: Cedars-Sinai Heart Institute, Los Angeles, California.
authors.forename: Jignesh
authors.initials: J
authors.lastname: Patel
authors.affiliation: Cedars-Sinai Heart Institute, Los Angeles, California.
authors.forename: Francisco
authors.initials: F
authors.lastname: Arabia
authors.affiliation: Cedars-Sinai Heart Institute, Los Angeles, California.
authors.forename: Jaime
authors.initials: J
authors.lastname: Moriguchi
authors.affiliation: Cedars-Sinai Heart Institute, Los Angeles, California.
authors.forename: Fardad
authors.initials: F
authors.lastname: Esmailian
authors.affiliation: Cedars-Sinai Heart Institute, Los Angeles, California. Electronic address: azarbalb@cshs.org.
authors.forename: Babak
authors.initials: B
authors.lastname: Azarbal
mesh_terms: D015199:Extracorporeal Membrane Oxygenation / Q000379:methods / Q000401:mortality / Q000639:trends*; D006801:Humans; D009205:Myocarditis / Q000175:diagnosis* / Q000628:therapy*; D010351:Patient Discharge / Q000639:trends; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
keywords: Heart failure; cardiac; cardiogenic shock; circulatory assistance