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Extracorporeal membrane oxygenation in adult patients with acute fulminant myocarditis

Clinical outcomes and risk factor analysis

Extrakorporale Membranoxygenierung bei erwachsenen Patienten mit akuter fulminanter Myokarditis

Klinische Ergebnisse und Risikofaktoranalyse

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Abstract

Background

Our study aimed to summarize the clinical outcomes of extracorporeal membrane oxygenation (ECMO) in adult patients with acute fulminant myocarditis and to investigate the risk factors associated with its application.

Patients and methods

We retrospectively examined patients with cardiogenic shock and acute fulminant myocarditis. The following data were collected: patients’ preoperative general condition, related clinical factors during ECMO, complications, and outcomes of ECMO. The patients were divided into a survivor group and a nonsurvivor group.

Results

From a total of 33 patients, seven died in hospital. The survival rate was 78.7%. The following complications were observed during ECMO: 16 cases of acute renal failure (48.4%), seven cases of sepsis (21.2%), six cases of pulmonary infection (18.1%), six cases of multiple organ failure (MOF; 18.1%), three cases of cerebral hemorrhage (9%), and four cases of limb ischemia (12.1%). Pre-ECMO cardiopulmonary resuscitation, high levels of lactic acid, high amounts of blood transfusion during ECMO, renal failure, encephalorrhagia, gastrointestinal complications, lower-limb ischemia, high bilirubin levels, and MOF during ECMO were associated with unfavorable patient outcomes.

Conclusion

ECMO is an effective auxiliary tool for treating acute fulminant myocarditis. Acute renal failure is the most common complication during ECMO. Improving tissue perfusion, reducing blood transfusions, and preventing acute kidney failure may improve patient outcomes.

Zusammenfassung

Hintergrund

Ziel der vorliegenden Studie war es, die klinischen Ergebnisse der extrakorporalen Membranoxygenierung (ECMO) bei erwachsenen Patienten mit akuter fulminanter Myokarditis zusammenzufassen und die mit dieser Therapie einhergehenden Risikofaktoren zu untersuchen.

Patienten und Methoden

Retrospektiv wurden die Daten von Patienten mit kardiogenem Schock und akuter fulminanter Myokarditis untersucht. Folgende Parameter wurden erhoben: präoperativer Ausgangszustand des Patienten, entsprechende klinische Faktoren in der ECMO-Phase, Komplikationen und Ergebnisse der ECMO. Die Patienten wurden unterteilt in eine Gruppe der Überlebenden und eine Gruppe der Nichtüberlebenden.

Ergebnisse

Von insgesamt 33 Patienten verstarben 7 im Krankenhaus. Die Überlebensrate betrug 78,7%. Während der ECMO wurden folgenden Komplikationen beobachtet: 16 Fälle von akutem Nierenversagen (48,4%), 7 Fälle von Sepsis (21,2%), 6 Fälle mit pulmonaler Infektion (18,1%), 6 Fälle mit multiplem Organversagen (MOF; 18,1%), 3 Fälle mit Hirnblutung (9%) und 4 Fälle mit Ischämie der Extremitäten (12,1%). Herz-Lungen-Wiederbelebung vor der ECMO, hohe Laktatwerte, große Mengen an Bluttransfusionen während der ECMO, Nierenversagen, Enzephalorrhagie, gastrointestinale Komplikationen, Ischämie der unteren Extremitäten, hohe Bilirubinwerte und MOF während der ECMO waren mit ungünstigen Ergebnissen im Krankheitsverlauf assoziiert.

Schlussfolgerung

Die ECMO stellt ein wirksames unterstützendes Verfahren zur Therapie der akuten fulminanten Myokarditis dar. Als häufigste Komplikation während der ECMO tritt das akute Nierenversagen auf. Die Verbesserung der Gewebeperfusion, Verminderung von Bluttransfusionen und Prävention des akuten Nierenversagens können die Therapieergebnisse verbessern.

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Authors and Affiliations

  1. Department of Anesthesiology, Zhongshan Hospital Affiliated to Sun Yat-sen University, East Sunwen Road, Zhongshan City, 528403, Zhongshan, Guangdong Province, China

    X. Liao, B. Li & Z. Cheng

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  1. X. Liao
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  2. B. Li
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  3. Z. Cheng
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Corresponding authors

Correspondence to X. Liao or B. Li.

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Conflict of interest

X. Liao, B. Li, and Z. Cheng declare that they have no competing interests.

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Liao, X., Li, B. & Cheng, Z. Extracorporeal membrane oxygenation in adult patients with acute fulminant myocarditis. Herz 43, 728–732 (2018). https://doi.org/10.1007/s00059-017-4617-7

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  • DOI: https://doi.org/10.1007/s00059-017-4617-7

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