Extracorporeal membrane oxygenation for fulminant myocarditis: A 10-year multidisciplinary experience

Abstract

Background Fulminant myocarditis is a life-threatening condition characterized by hemodynamic instability leading to cardiogenic shock or cardiac arrest. Veno-arterial extracorporeal membrane oxygenation (ECMO) could be used in patients refractory to conventional treatment. Purpose We aimed to investigate the clinical characteristics and outcomes of fulminant myocarditis patients managed with ECMO at a single-centre, multidisciplinary experience. Methods We performed a retrospective observational analysis of our local database. The diagnosis of myocarditis was made from clinical, biologic and imaging criteria according to European guidelines. The primary endpoint was survival to hospital discharge. Results Of the 577 patients who had ECLS from January 2010 to December 2019, 16 (2.7%) were treated for fulminant myocarditis. The mean age was 38.5 years (range 21–69 years) and 68.7% were female. Main symptoms at hospital admission were: chest pain (N\xa0=\xa06, 37.5%), heart failure (N\xa0=\xa06, 37.5%), syncope (N\xa0=\xa03, 18.7%) and cardiogenic shock (N\xa0=\xa01, 6.2%). Seven (43.7%) patients presented a flu-like syndrome prior to the first medical contact. Complementary diagnostic tools included endomyocardial biopsy (N\xa0=\xa08, 50%) and cardiac magnetic resonance imaging (N\xa0=\xa07, 43.7%). ECMO was implanted during on-going cardiopulmonary resuscitation in 2 (12.5%) patients. Five (31.3%) patients died during ECMO support while 10 (62.5%) were successfully weaned after a mean ECMO support of 9.3 days. One (6.2%) patient was switched to a left ventricular assist device as a bridge-to-transplantation. Overall survival to hospital discharge was 68.7% (N\xa0=\xa011). After the acute phase, most (72.7%) of the survivors displayed a normal left ventricular ejection fraction at hospital discharge. Conclusion ECMO offered a satisfactory survival to hospital discharge in these critically ill patients. Our results underscore the high potential of myocardial recovery after the acute phase of fulminant myocarditis.