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Hao T, Jiang Y, Wu C, Li C, Chen C, Xie J, Pan C, Guo F, Huang Y, Liu L, Xie H, Du Z, Hou X, Liu S, Yang Y, Qiu H. Clinical outcome and risk factors for acute fulminant myocarditis supported by venoarterial extracorporeal membrane oxygenation: An analysis of nationwide CSECLS database in China. Int J Cardiol 2023; 371:229-235. [PMID: 36174824 DOI: 10.1016/j.ijcard.2022.09.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 08/04/2022] [Accepted: 09/21/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND To assess the outcomes and risk factors for adult patients with acute fulminant myocarditis (AFM) supported with venoarterial extracorporeal membrane oxygenation (VA ECMO) in China mainland. METHODS Data were extracted from Chinese Society of ExtraCorporeal Life Support (CSECLS) Registry database. Data from adult patients who were diagnosed with AFM and needed VA ECMO in the database were retrospectively analyzed. The primary outcome was 90-day mortality after ECMO initiation in patients with AFM supported with VA ECMO. Cox proportional hazard regression model was used to examine the risk factors associated with 90-day mortality. RESULTS Among 221 patients enrolled and followed up to 90 days, 186 (84.2%) patients weaned from ECMO and 159 (71.9%) patients survived and discharged home. The median age was 38 years (IQR 29-49) and males (n = 115) represented 52.0% of the total accounted patients. The median ECMO duration was 134 h (IQR 96-177 h). The main adverse event during ECMO course was bleeding (16.3%), followed by infection (15.4%). In the multivariate Cox model analysis, cardiac arrest prior to ECMO initiation (adjusted HR 2.529; 95%CI: 1.341-4.767, p = 0.004), lower pH value (adjusted HR 0.016; 95%CI: 0.010-0.059, p < 0.001) and higher lactate concentration at 24 h after ECMO initiation (adjusted HR 1.146; 95%CI: 1.075-1.221, p < 0.001) were associated with 90-day mortality. CONCLUSIONS 71.9% patients with AFM (clinical diagnosed) supported with VA ECMO survived. Cardiac arrest prior to ECMO, lower pH and higher lactate concentration at 24 h after ECMO initiation were correlated with 90-day mortality of AFM patients supported with VA ECMO.
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Affiliation(s)
- Tong Hao
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu 210009, People's Republic of China
| | - Yu Jiang
- Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Changde Wu
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu 210009, People's Republic of China
| | - Chenglong Li
- Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Chuang Chen
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu 210009, People's Republic of China
| | - Jianfeng Xie
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu 210009, People's Republic of China
| | - Chun Pan
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu 210009, People's Republic of China
| | - Fengmei Guo
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu 210009, People's Republic of China
| | - Yingzi Huang
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu 210009, People's Republic of China
| | - Ling Liu
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu 210009, People's Republic of China
| | - Haixiu Xie
- Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Zhongtao Du
- Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Xiaotong Hou
- Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Songqiao Liu
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu 210009, People's Republic of China; Nanjing Lishui People's Hospital, Zhongda Hospital Lishui Branch, Southeast University, No. 86 Chongwen Road, Lishui District, Nanjing 211200, Jiangsu, People's Republic of China.
| | - Yi Yang
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu 210009, People's Republic of China.
| | - Haibo Qiu
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu 210009, People's Republic of China
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Chen RX, Shi JY, Ren YQ, Wang F, Zhou YP, Cui Y. [Clinical features and outcomes of pediatric acute fulminant myocarditis requiring extracorporeal membrane oxygenation]. Zhonghua Yi Xue Za Zhi 2020; 99:3715-3719. [PMID: 31874496 DOI: 10.3760/cma.j.issn.0376-2491.2019.47.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To observe the clinical features and effects of extracorporeal membrane oxygenation (ECMO) in critically ill children with acute fulminant myocarditis (AFM). Methods: A retrospective analysis was performed in pediatric patients with AFM requiring ECMO, from December 2015 to December 2018, who were admitted to the Pediatric Intensive Care Unit (PICU) in Shanghai Children's Hospital. According to whether patient was alive at least 48 hours after weaning, the children were divided into successful weaning group (9 cases) and unsucessful weaning group (3 cases). The factors related to successful ECMO weaning were explored. The changes of clinical and biochemical parameters before and after ECMO treatment in successful weaning group were analyzed. Continuous variables were presented as median (inter quartile range) for abnormal distribution data, and Mann-Whitney U test was used to compare the data. Results: A total of 12 pediatric patients including 4 males and 8 females were enrolled in this study. The median body weight was 20 (17, 36) kg, and the median age was 66 (48, 103) months. Nine cases were successfully weaned from ECMO, and 8 cases survived to discharge, and 4 cases died in the hospital. The median interval between symptoms onset and ECMO establishment was 3.0 (2.2, 4.0) days, the median duration of ECMO support was 120 (68, 152) hours. In the unsuccessful weaning group, patients displayed higher levels of initiallactic acid (LA), higher vasoactive-inotropic score (VIS), and longer QRS duration before ECMO establishment when compared with those in the successful weaning group (all P<0.05). After ECMO establishment, mean arterial pressure (MAP), systemic central venous oxygen saturation, LA, myocardial injury markers and left ventricular ejection fraction were all significantly improved in the successful weaning group (all P<0.05). Conclusion: In pediatric AFM patients, serum LA level, VIS and QRS duration before ECMO establishment are associated with successful ECMO weaning.
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Affiliation(s)
- R X Chen
- Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai 200062, China
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Saito N, Shimizu K, Kawaishi M, Araya J, Nakayama K, Kuwano K. A survival case of invasive thymoma accompanied by acute fulminant myocarditis. Respirol Case Rep 2013; 1:36-8. [PMID: 25473538 PMCID: PMC4184523 DOI: 10.1002/rcr2.6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 06/22/2013] [Accepted: 06/27/2013] [Indexed: 11/14/2022] Open
Abstract
Thymomas are associated with a wide spectrum of autoimmune paraneoplastic diseases. Here we report the case of 31-year-old male with invasive thymoma, myasthenia gravis, polymyositis, and acute fulminant myocarditis that presented with cardiogenic shock requiring intra-aortic balloon pumping and percutaneous cardiopulmonary support. Corticosteroid therapy was effective. To our knowledge, this is the first case of thymoma with acute fulminant cardiomyositis that was successfully treated by assisted circulation and corticosteroids, despite a poor prognosis.
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Affiliation(s)
- Nayuta Saito
- Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University School of Medicine Tokyo, Japan
| | - Kenichiro Shimizu
- Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University School of Medicine Tokyo, Japan
| | - Makoto Kawaishi
- Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University School of Medicine Tokyo, Japan
| | - Jun Araya
- Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University School of Medicine Tokyo, Japan
| | - Katsutoshi Nakayama
- Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University School of Medicine Tokyo, Japan
| | - Kazuyoshi Kuwano
- Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University School of Medicine Tokyo, Japan
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