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Mechanical Circulatory Support in Pediatric Myocarditis: Support Strategies and Outcomes in a Nationally

Alicia M Kamsheh1, Jonathan B Edelson2, Jennifer Faerber3

  • 1Division of Pediatric Cardiology, Washington University School of Medicine, St. Louis, MO.

JHLT Open
|July 17, 2024
PubMed

Insights

Mechanical circulatory support (MCS) is increasingly used for pediatric myocarditis, with extracorporeal membrane oxygenation (ECMO) being most common. While mortality remains high, outcomes do not significantly differ between ECMO and other MCS strategies in this patient population.

Area of Science:

  • Pediatric Cardiology
  • Critical Care Medicine
  • Cardiovascular Surgery

Background:

  • Myocarditis frequently causes pediatric heart failure, often necessitating mechanical circulatory support (MCS).
  • Understanding MCS strategies and outcomes in pediatric myocarditis is crucial for improving patient care.

Purpose of the Study:

  • To describe the utilization of various MCS strategies in a nationwide cohort of pediatric patients diagnosed with myocarditis.
  • To identify temporal trends in MCS use for pediatric myocarditis.
  • To compare patient outcomes across different MCS strategies.

Main Methods:

  • Utilized the Kids' Inpatient Database (KID), a national administrative discharge data sample from 2003-2016.
  • Identified pediatric myocarditis admissions using ICD-9/10 codes.
  • Compared MCS outcomes using logistic regression analysis.

Main Results:

  • MCS was employed in 7.5% of 5,661 pediatric myocarditis admissions.
  • Extracorporeal membrane oxygenation (ECMO) was the predominant MCS strategy (73.6%), including extracorporeal cardiopulmonary resuscitation (ECPR).
  • Mortality was high (28.3%) among patients receiving MCS, with no significant differences in mortality observed between VAD-only/combination MCS and non-ECPR ECMO groups.

Conclusions:

  • Mechanical circulatory support is utilized in approximately 1 in 13 pediatric myocarditis cases, with increasing trends over time.
  • ECMO remains the most frequently used MCS modality, despite high overall mortality.
  • Further prospective studies are needed to definitively assess the comparative effectiveness of different MCS modalities in pediatric myocarditis.
Abstract

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