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Contemporary Care and Outcomes of Critically-ill Children With Clinically Diagnosed Myocarditis
David M Peng1, David M Kwiatkowski2, Javier J Lasa3
1University of Michigan, CS Mott Children's Hospital, 1540 East Hospital Drive, Ann Arbor, MI.
Insights
Pediatric myocarditis patients admitted to the cardiac intensive care unit (CICU) often require advanced therapies like mechanical ventilation and extracorporeal membrane oxygenation (ECMO). Smaller body size and acute kidney injury are linked to mortality in these critically ill children.
Area of Science:
- Pediatric Cardiology
- Critical Care Medicine
- Pediatric Critical Care
Background:
- Myocarditis is a significant cause of pediatric heart failure.
- Outcomes for pediatric myocarditis vary, necessitating research into contemporary management.
- Cardiac intensive care units (CICUs) manage severe pediatric myocarditis cases.
Purpose of the Study:
- To describe current management strategies for pediatric myocarditis in CICUs.
- To analyze outcomes of children with myocarditis admitted to CICUs.
- To identify factors associated with in-hospital mortality in pediatric myocarditis.
Main Methods:
- Retrospective analysis of the Pediatric Cardiac Critical Care Consortium (PC4) registry (August 2014 - June 2021).
- Inclusion of patients diagnosed with myocarditis admitted to a CICU.
- Univariable and multivariable logistic regression to identify mortality predictors.
Main Results:
- 847 pediatric myocarditis CICU admissions were analyzed.
- In-hospital mortality was 6.3%; 7.1% experienced cardiac arrest.
- Mechanical circulatory support (MCS), mechanical ventilation, and extracorporeal membrane oxygenation (ECMO) were frequently used; MCS was associated with mortality (20.3% vs 2.5%).
- Smaller body surface area (BSA) and lower estimated glomerular filtration rate (eGFR) were independently associated with mortality.
- Mechanical ventilation and ECMO were independent predictors of mortality.
Conclusions:
- Contemporary pediatric myocarditis management in CICUs involves high-resource therapies.
- Most children with myocarditis admitted to CICU survive to discharge.
- Smaller patient size, acute kidney injury, and receipt of mechanical ventilation or ECMO independently predict mortality.
Purpose:
To describe contemporary management and outcomes in children with myocarditis who are admitted to a cardiac intensive care unit (CICU) and to identify the characteristics associated with mortality.
Methods:
All patients in the Pediatric Cardiac Critical Care Consortium (PC4) registry between August 2014 and June 2021 who were diagnosed with myocarditis were included. Univariable analyses and multivariable logistic regression evaluated the factors associated with in-hospital mortality.
Results:
There were 847 CICU admissions for myocarditis in 51 centers. The median age was 12 years (IQR 2.7-16). In-hospital mortality occurred in 53 patients (6.3%), and 60 (7.1%) had cardiac arrest during admission. Mechanical ventilation was required in 339 patients (40%), and mechanical circulatory support (MCS) in 177 (21%); extracorporeal membrane oxygenation (ECMO)-only in 142 (16.7%), ECMO-to-ventricular assist device (VAD) in 20 (2.4%), extracorporeal cardiac resuscitation in 43 (5%), and VAD-only in 15 (1.8%) patients. MCS was associated with in-hospital mortality; 20.3% receiving MCS died compared to 2.5% without MCS (P < 0.001). Mortality rates were similar in ECMO-only, ECMO-to-VAD and VAD-only groups. The median time from CICU admission to ECMO was 2.0 hours (IQR 0-9.4) and to VAD, it was 9.9 days (IQR 6.3-16.8). Time to MCS was not associated with mortality. In multivariable modeling of patients' characteristics, smaller body surface area (BSA) and low eGFR were independently associated with mortality, and after including critical therapies, mechanical ventilation and ECMO were independent predictors of mortality.
Conclusion:
This contemporary cohort of children admitted to CICUs with myocarditis commonly received high-resource therapies; however, most patients survived to hospital discharge and rarely received VAD. Smaller patient size, acute kidney injury and receipt of mechanical ventilation or ECMO were independently associated with mortality.
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