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Published on: January 17, 2025
Predictors of Extracorporeal Membrane Oxygenation Support for Children with Acute Myocarditis
Han-Ping Wu1,2, Mao-Jen Lin3,4, Wen-Chieh Yang5,6
1Division of Pediatric General Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linko, Kweishan, Taoyuan, Taiwan.
Insights
Female sex, vomiting, seizures, and low ejection fraction in children with acute myocarditis may predict the need for extracorporeal membrane oxygenation (ECMO) support.
Area of Science:
- Pediatric Cardiology
- Critical Care Medicine
Background:
- Acute myocarditis in children presents with a wide range of symptoms, from mild to severe, including sudden cardiac arrest.
- Early identification of children requiring advanced support like extracorporeal membrane oxygenation (ECMO) is crucial for timely intervention.
Purpose of the Study:
- To analyze the clinical spectrum of acute myocarditis in children.
- To identify predictors for extracorporeal membrane oxygenation (ECMO) need in pediatric patients.
- To assist primary care physicians in prompt consultation with pediatric cardiologists.
Main Methods:
- Retrospective analysis of 60 pediatric patients (≤18 years) diagnosed with acute myocarditis between October 2011 and September 2016.
- Data collection included demographics, clinical presentation, laboratory tests, ECG, echocardiography, treatments, and outcomes.
- Statistical analysis to compare patients who received ECMO versus those who did not.
Main Results:
- Fever, cough, and chest pain were the most frequent symptoms.
- Arrhythmia, left ventricular ejection fraction (LVEF) < 60%, vomiting, weakness, and seizure were significantly more common in the ECMO group.
- A serum troponin-I cutoff of >14.21 ng/mL indicated a need for ECMO.
Conclusions:
- Female sex, vomiting, weakness, seizure, arrhythmia, and LVEF < 60% are potential predictors for ECMO in pediatric acute myocarditis.
- Early recognition of these factors can facilitate prompt consultation and intervention by pediatric cardiologists.
- Serum troponin-I levels may serve as an additional biomarker for predicting ECMO necessity.
Abstract:
The clinical presentation of acute myocarditis in children may range from asymptomatic to sudden cardiac arrest. This study analyzed the clinical spectrum of acute myocarditis in children to identify factors that could aid primary care physicians to predict the need for extracorporeal membrane oxygenation (ECMO) earlier and consult the pediatric cardiologist promptly. Between October 2011 and September 2016, we retrospectively analyzed 60 patients aged 18 years or younger who were admitted to our pediatric emergency department with a definite diagnosis of acute myocarditis. Data on demographics, presentation, laboratory tests, electrocardiogram and echocardiography findings, treatment modalities, complications, and long-term outcomes were obtained. During the study period, 60 patients (32 male, 28 female; mean age, 8.8 ± 6.32 years) were diagnosed with acute myocarditis. Fever, cough, and chest pain were the most common symptoms (68.3%, 56.7%, and 53.3%, resp.). Arrhythmia and left ventricular ejection fraction (LVEF) < 60%, vomiting, weakness, and seizure were more common in the ECMO group than in the non-ECMO group, with statistical significance (P < 0.05). Female sex, vomiting, weakness, seizure, arrhythmia, and echocardiography showing LVEF < 60% may predict the need for ECMO. Initial serum troponin-I cutoff values greater than 14.21 ng/mL may also indicate the need for ECMO support for children with acute myocarditis.
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