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Management and outcomes in pediatric patients presenting with acute fulminant myocarditis

Sarah A Teele1, Catherine K Allan, Peter C Laussen

  • 1Department of Cardiology, Children's Hospital Boston, Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA. sarah.teele@cardio.chboston.org

The Journal of Pediatrics
|January 4, 2011
PubMed

Insights

Acute fulminant myocarditis patients needing mechanical circulatory support often show organ dysfunction. This study found an 80% transplant-free survival rate in critically ill children with acute fulminant myocarditis.

Area of Science:

  • Pediatric Cardiology
  • Critical Care Medicine
  • Myocardial Diseases

Background:

  • Acute fulminant myocarditis (AFM) is a severe condition characterized by rapid-onset heart failure.
  • Mechanical circulatory support (MCS) is a critical intervention for patients with severe AFM.
  • Understanding factors influencing MCS need and survival is vital for patient outcomes.

Purpose of the Study:

  • To identify factors associated with the need for mechanical circulatory support.
  • To determine predictors of survival in patients with acute fulminant myocarditis.
  • To evaluate the efficacy of extracorporeal membrane oxygenation (ECMO) in this cohort.

Main Methods:

  • Retrospective cohort study of AFM patients admitted to a cardiac intensive care unit (1996-2008).
  • AFM definition included rapid cardiogenic shock and normal left ventricular size.
  • Comparison of demographic and physiological variables between patients receiving ECMO and those not, and between survivors and non-survivors.

Main Results:

  • Seventeen of twenty pediatric patients (85%) survived to discharge; one received a heart transplant.
  • Ten patients (50%) required ECMO, with 70% survival among them.
  • ECMO patients had higher admission lactate, creatinine, and AST levels, and a trend towards more dysrhythmias.

Conclusions:

  • End-organ dysfunction and arrhythmias on admission may indicate the need for MCS in AFM patients.
  • The transplant-free survival rate of 80% in this critically ill cohort is encouraging.
  • Early identification of high-risk factors is crucial for timely intervention and improved outcomes.
Abstract

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