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| The effect and factors associated with outcome of extracorporeal membrane oxygenation in acute fulminant myocarditis patients |
| Zhou Zhu-jiang, Liu Chang-zhi, Zhu Rui-qiu, Lu Jian-hai, Zuo Liu-er |
| Department of Critical Care Medicine, Shunde Hospital, Southern Medical University, Foshan 528300, China |
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Abstract Objective To observe the clinical efficacy and factors associated with outcome of extracorporeal membrane oxygenation (ECMO) in acute fulminant myocarditis (AFM) patients. Methods Patients with AFM received ECMO treatment in the Shunde Hospital of Southern Medical University from May 2013 to December 2017 were retrospectively analyzed. The clinical status before ECMO support, supported timing of ECMO, complications and outcome of ECMO were observed and collected. The hemodynamic data 2 hours before ECMO support and after ECMO support (2, 6, 24 and 48 hours) were collected. Results Fourteen patients were enrolled in the age range of 15.0 (12.8, 32.2) that contained 8 female. Median score of APACHEⅡ was 17.0 (14.5, 21.8). Mean lactate was (9.0±4.4) years, mean CK-MB was (187.1±142.3) U/L. Meanwhile median troponin I was 12.1 (9.7, 31.8) ng/mL, mean LVEF was (26.8±6.8)%. Before ECMO support, large dose of vasoactive medications were used, and mean inotropic equivalents was (159.8±151.4). The indication for ECMO included refractory cardiogenic shock (n=12) and long-term conventional cardiopulmonary resuscitation without return of spontaneous circulation (n=2). After ECMO was supported for 2 hours, HR decreased (122.7±41.8 vs. 94.2±31.9, F=3.468, P=0.012), MAP increased (64.9±14.1 vs. 74.9±9.5, F=2.609, P=0.043), CVP decreased (15.2±3.5 vs. 13.0±3.2，F=2.910, P=0.028), ScvO2 increased (54.8±10.0 vs. 70.9±9.1, F=12.270, P＜0.001), dose of inotropic drugs decreased (159.8±151.4 vs. 50.9±59.6, F=8.037, P＜0.001). After ECMO was supported for six hours, lactate level decreased. There was no significant increase in pulse pressure after ECMO support. When ECMO was supported for 24 or 48 hours, hemodynamics kept stable and shock was significantly controlled. Major limb complications were observed in two patients, which contained limb ischemia (n=1) rupture of femoral artery with limb ischemia and abscess (n=1). Acute renal failure occurred in six patients and septic shock in two patients. The ECMO duration was (143.8±100.8) h. Weaning was 85.7% (n=12) and survival to discharge was 78.6% (n=11). One patients died from cerebral abscess, and two patients died from septic shock. Conclusion ECMO improves hemodynamics rapidly in acute fulminant myocarditis patient. Accurate assessment the opportunity of ECMO support helps decrease complication of ECMO and improve therapeutic efficacy.
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Corresponding Authors:
Zuo Liu-er, E-mail: 13500276597@163.com
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