Background:
Peripheral venoarterial extracorporeal membranous oxygenation (ECMO) support is effective in patients with cardiogenic shock or fatal arrhythmia due to fulminant myocarditis. The clinical courses of fulminant myocarditis are still uncertain; therefore, it is difficult to determine the appropriate time for discontinuing ECMO or converting to a ventricular assist device. The purpose of this study was to investigate the prognosis of patients with fulminant myocarditis managed by ECMO.
Methods:
Twenty-two consecutive patients with fulminant myocarditis managed by peripheral venoarterial ECMO between 1999 and 2013 were enrolled.
Results:
Survival to discharge was 59% (13 patients), and in-hospital mortality was 41% (9 patients). The age in the survivor group was significantly lower than that in the non-survivor group (survivor group vs. non-survivor group; 36.5???4.1 vs. 60.2???5.0?years, p?=?0.001). Although the ECMO support duration was similar between the groups (181???22 vs. 177???31?h), the rate of complication related to ECMO was significantly lower in the survivor group (15.3% vs. 66.6%, p?=?0.02). When comparing the laboratory data during ECMO management between the groups, the serum bilirubin level on day 7 was significantly lower in the survivor group (total: 4.6???2.8 vs. 13.7???10.8?mg/dL, p?=?0.014; direct: 2.2???0.5 vs. 9.8???4.5?mg/dL, p?=?0.009).
Conclusions:
Fulminant myocarditis is associated with high mortality rates despite ECMO. An older age and complications related to ECMO are associated with poor prognosis.
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