Pediatric Acute Myocarditis With Short-Term Outcomes and Factors for Extracorporeal Membrane Oxygenation: A...

Area of Science:

• Pediatric Cardiology
• Critical Care Medicine
• Extracorporeal Life Support

Background:

• Limited data exists on acute myocarditis management and outcomes using extracorporeal membrane oxygenation (ECMO) in low- and middle-income countries.
• Acute myocarditis in children can lead to severe hemodynamic compromise requiring advanced support.
• Understanding outcomes and predictors of ECMO use is crucial for improving pediatric critical care in resource-limited settings.

Purpose of the Study:

• To determine the short-term outcomes of pediatric acute myocarditis patients treated with ECMO.
• To identify factors associated with ECMO use and outcomes in children with acute myocarditis.
• To provide insights into ECMO management for acute myocarditis in a tertiary Vietnamese hospital.

Main Methods:

• A retrospective observational study was conducted from January 2016 to February 2021.
• Included were pediatric patients aged 1 month to 16 years diagnosed with acute myocarditis.
• Data analysis focused on short-term outcomes, ECMO utilization, and associated clinical and laboratory variables.

Main Results:

• A total of 54 pediatric patients with acute myocarditis were analyzed; 37 received ECMO support.
• The overall case fatality rate was 30% (16/54), with 32% (12/37) mortality among ECMO patients.
• Factors associated with non-survival included lower left ventricular ejection fraction (LVEF) at 48 hours, lower platelet count, lower protein levels, and higher vasoactive-inotropic score and lactate levels post-ECMO.

Conclusions:

• Acute myocarditis carries a significant mortality risk, particularly for children requiring ECMO support.
• Low LVEF, elevated lactate, and high vasoactive-inotropic scores post-ECMO are indicators of poor prognosis.
• Arrhythmia in the context of cardiogenic shock was identified as an indicator for ECMO initiation.