ISSN: 1859 - 2872
Treatment outcomes of extracorporeal membrane oxygenation (ECMO) in patients with acute myocarditis complicated by cardiogenic shock at 175 Military Hospital
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Abstract
Objective: To evaluate the effectiveness of extracorporeal membrane oxygenation (ECMO) in circulatory support for patients with acute myocarditis and cardiogenic shock in the Intensive Care Unit at 175 Military Hospital. Subject and method: A descriptive, longitudinal, non-controlled interventional study was conducted on 42 patients diagnosed with myocarditis complicated by cardiogenic shock, treated at the Intensive Care Unit of 175 Military Hospital from January 2022 to December 2024. Result: The study included 42 patients with cardiogenic shock who received ECMO support, with a mean age of 36.7 ± 11.4 years and 64.3% being male. Initial parameters indicated critical condition: Systolic blood pressure 78 ± 12mmHg, EF 28 ± 7.5%, lactate 6.2 ± 2.1mmol/L, NT-proBNP 18,400 ± 7,300pg/mL, and SOFA score 10 ± 2.8. After ECMO, hemodynamic parameters improved significantly: Mean arterial pressure increased from 55.3 ± 8.1 to 79.5 ± 6.2mmHg (p<0.001), lactate levels decreased from 7.8 ± 3.1 to 1.5 ± 0.8mmol/L (p<0.001). Cardiac function recovered notably with EF rising to 53 ± 8.7% after 14 days. During ECMO therapy, 100% of patients received broad-spectrum antibiotics and continuous anticoagulation. Complications included bleeding (21.4%), thrombosis (9.5%), and acute kidney injury (26.2%). ECMO weaning success rate was 78.6%, with a hospital mortality rate of 21.4%. Conclusion: ECMO improves hemodynamics, cardiac function, and survival in patients with severe acute heart failure. However, complications remain common, necessitating close monitoring and active management. Early ECMO initiation may enhance treatment outcomes.
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References
2. Lorusso R, Gelsomino S, Parise O et al (2017) Venoarterial Extracorporeal Membrane Oxygenation for Refractory Cardiogenic Shock in Elderly Patients: Trends in Application and Outcome From the Extracorporeal Life Support Organization (ELSO) Registry. Annals of Thoracic Surgery 104(1): 62-69. doi:10.1016/j.athoracsur.2016.10.023.
3. Cheng R, Hachamovitch R, Kittleson M et al (2014) Complications of extracorporeal membrane oxygenation for treatment of cardiogenic shock and cardiac arrest: a meta-analysis of 1,866 adult patients. Ann Thorac Surg 97(2): 610-616. doi:10.1016/j.athoracsur.2013.09.008.
4. Caforio ALP, Pankuweit S, Arbustini E et al (2013) Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J 34(33): 2636-2648. doi:10.1093/eurheartj/eht210.
5. Members AF, McMurray JJV, Adamopoulos S et al (2012) ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012. European Journal of Heart Failure 14(8): 803-869. doi:10.1093/eurjhf/hfs105.
6. Kytö V, Sipilä J, Rautava P (2013) The effects of gender and age on occurrence of clinically suspected myocarditis in adulthood. Heart 99(22): 1681-1684. doi:10.1136/heartjnl-2013-304449.
7. Nakamura T, Ishida K, Taniguchi Y, et al (2015) Prognosis of patients with fulminant myocarditis managed by peripheral venoarterial extracorporeal membranous oxygenation support: a retrospective single-center study. Journal of Intensive Care 3(1): 5. doi:10.1186/s40560-014-0069-9.
8. Kim DH, Cho WH, Son J, Lee SK, Yeo HJ (2021) Catastrophic Mechanical Complications of Extracorporeal Membrane Oxygenation. ASAIO Journal. 67(9): 1000. doi:10.1097/MAT.0000000000001354.
9. Smith M, Vukomanovic A, Brodie D, Thiagarajan R, Rycus P, Buscher H (2017) Duration of veno-arterial extracorporeal life support (VA ECMO) and outcome: an analysis of the Extracorporeal Life Support Organization (ELSO) registry. Critical Care 21(1): 45. doi:10.1186/s13054-017-1633-1.
10. Vogel DJ, Murray J, Czapran AZ et al (2018) Veno-arterio-venous ECMO for septic cardiomyopathy: A single-centre experience. Perfusion. 33(1_suppl):57-64. doi:10.1177/0267659118766833.
11. Byun E, Kang PJ, Jung SH et al (2024) Impact of extracorporeal membrane oxygenation-related complications on in-hospital mortality. PLOS ONE 19(3): 0300713. doi:10.1371/journal.pone.0300713.
12. Gomez F, Veita J, Laudanski K (2022) Antibiotics and ECMO in the Adult Population Persistent Challenges and Practical Guides. Antibiotics (Basel) 11(3):338. doi:10.3390/antibiotics11030338.
13. Chung C, Ko H, Byun JH, Kim TH, Lee HD (2022) Kawasaki disease shock syndrome rescued by a combination of extracorporeal membrane oxygenation, steroids, and intravenous immunoglobulin. Pediatr Emerg Med J 9(1): 48-51. doi:10.22470/pemj.2022.00479.
14. Vishram-Nielsen JKK, Foroutan F, Rizwan S et al (2023) Patients with fulminant myocarditis supported with veno-arterial extracorporeal membrane oxygenation: a systematic review and meta-analysis of short-term mortality and impact of risk factors. Heart Fail Rev 28(2): 347-357. doi:10.1007/s10741-022-10277-z.
15. Staibano P, Khattak S, Amin F, Engels PT, Sommer DD (2023) Tracheostomy in Critically Ill COVID-19 Patients on Extracorporeal Membrane Oxygenation: A Single-Center Experience. Ann Otol Rhinol Laryngol 132(12): 1520-1527. doi:10.1177/00034894231166648.
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