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Effects of the elective introduction of extracorporeal membrane oxygenation on outcomes in pediatric myocarditis
Nobuyuki Nosaka1,2, Takashi Muguruma1, Takeo Fujiwara3
1Division of Acute and Critical Care Department of Critical Care and Anesthesia National Medical Center for Children and Mothers Tokyo Japan.
Insights
Pediatric myocarditis diagnosis requires considering gastrointestinal and central nervous system symptoms. Early extracorporeal membrane oxygenation (ECMO) improves outcomes, with creatinine levels predicting mortality in children.
Area of Science:
- Pediatric Cardiology
- Critical Care Medicine
- Pediatric Infectious Diseases
Background:
- Myocarditis is a serious condition in children, often presenting with non-specific symptoms.
- Early diagnosis and appropriate management are crucial for improving survival and neurological outcomes.
Purpose of the Study:
- To identify key indicators for diagnosing pediatric myocarditis.
- To determine appropriate candidates for extracorporeal membrane oxygenation (ECMO) therapy.
- To identify predictors of mortality in pediatric myocarditis patients.
Main Methods:
- Retrospective review of medical records of children (<16 years) diagnosed with myocarditis.
- Data collection included demographics, symptoms, signs, survival, and neurological outcomes.
- Multivariate analysis (stepwise logistic regression) was used to identify predictors of death.
Main Results:
- Fever and gastrointestinal symptoms were common initial signs (~80%).
- Central nervous system symptoms were frequent on emergency presentation (41%).
- Creatinine level emerged as an independent predictor of death.
Conclusions:
- Consider myocarditis in children presenting with gastrointestinal or central nervous system symptoms.
- Elective ECMO initiation before end-organ dysfunction positively impacts outcomes.
- Prompt transfer for ECMO support is vital in managing pediatric myocarditis.
Aim:
To investigate the necessary indicators to diagnose pediatric myocarditis and choose appropriate candidates for extracorporeal membrane oxygenation therapy.
Methods:
We retrospectively reviewed the medical records of children aged <16 years of age who were diagnosed with myocarditis and admitted to the pediatric intensive care unit in a Japanese children's hospital from 2002 to 2013. We collected demographic data and symptoms and signs during the entire clinical course, investigated the survival and neurological outcomes, and identified the predictors of death.
Results:
Twenty-nine patients (median age, 5 years) met the inclusion criteria. Fever and gastrointestinal symptoms occurred in approximately 80% of the patients as initial symptoms and central nervous system symptoms were the most frequent symptom on emergency presentation (41%). Extracorporeal membrane oxygenation was administered to 16 patients; of these, five died. Of the 24 surviving patients, 23 achieved favorable neurological outcomes. Four of eight patients died following cardiopulmonary resuscitation-triggered extracorporeal membrane oxygenation, and one of eight died following elective extracorporeal membrane oxygenation. Multivariate analysis using stepwise logistic regression analysis revealed creatinine level as an independent predictor of death.
Conclusion:
It is important to consider myocarditis when evaluating children with gastrointestinal or central nervous system symptoms. The elective introduction of extracorporeal membrane oxygenation before the completion of end-organ dysfunction has a positive effect on outcomes in pediatric myocarditis cases. Transfer to an institution that can initiate extracorporeal membrane oxygenation support should be promptly considered when managing pediatric myocarditis.
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