title: Peripheral Veno-Arterial Extracorporeal Membrane Oxygenation as a Bridge to Decision for Pediatric Fulminant Myocarditis.
abstract: It is essential to establish an appropriate initial treatment strategy for pediatric fulminant myocarditis. We reviewed eight cases of pediatric fulminant myocarditis that required extracorporeal membrane oxygenation (ECMO) from 2012 to 2015. The median age was 8 years (range 3 months-13 years), and the median body surface area was 0.89 m(2) (range 0.35-1.34 m(2) ). Peripheral veno-arterial ECMO was initially applied, and we evaluated whether heart decompression was sufficient. If the pump flow was insufficient, central cannulation was performed via median sternotomy (central ECMO). The need for subsequent ventricular assist device (VAD) support was determined 72 h after ECMO initiation. Six patients were bridged to recovery using peripheral ECMO support only (for 3-11 days), whereas two required VAD support. One patient was switched to central ECMO before VAD implantation. Three patients died of multiorgan failure, even though cardiac function recovered in two of those patients. The duration from hospital arrival to ECMO initiation was shorter in the survival (3.3 ± 1.3 h; range 1.6-4.7 h) than in the nonsurvival group (32 ± 28 h; range 0.7-55 h). Peripheral ECMO can be useful as a bridge to decision for pediatric fulminant myocarditis, which is frequently followed by a successful bridge to recovery. It is important to determine whether ECMO support should be initiated before organ dysfunction advances to preserve organ function, which provides a better bridge to subsequent VAD therapy and heart transplant or recovery.
authors.affiliation: Department of Cardiovascular Surgery, Aichi Children's Health and Medical Center, Aichi, Japan.
authors.forename: Noritaka
authors.initials: N
authors.lastname: Okada
authors.affiliation: Department of Cardiovascular Surgery, Aichi Children's Health and Medical Center, Aichi, Japan.
authors.forename: Hiroomi
authors.initials: H
authors.lastname: Murayama
authors.affiliation: Department of Cardiovascular Surgery, Aichi Children's Health and Medical Center, Aichi, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Hasegawa
authors.affiliation: Department of Pediatric Cardiology, Aichi Children's Health and Medical Center, Aichi, Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Kawai
authors.affiliation: Department of Pediatric Cardiology, Aichi Children's Health and Medical Center, Aichi, Japan.
authors.forename: Hiromitsu
authors.initials: H
authors.lastname: Mori
authors.affiliation: Department of Pediatric Cardiology, Aichi Children's Health and Medical Center, Aichi, Japan.
authors.forename: Kazushi
authors.initials: K
authors.lastname: Yasuda
mesh_terms: D000293:Adolescent; D006348:Cardiac Surgical Procedures; D002648:Child; D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D006321:Heart / Q000503:physiopathology; D006353:Heart-Assist Devices; D006801:Humans; D007223:Infant; D008297:Male; D009205:Myocarditis / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D009206:Myocardium / Q000473:pathology
keywords: Bridge to decision; Extracorporeal membrane oxygenation; Fulminant myocarditis; Pediatric