Favorable clinical outcome in patients with cardiogenic shock due to fulminant myocarditis supported by extracorporeal membrane oxygenation: Comparison with those with acute (nonfulminant) myocarditis

Yasuhide Asaumi, Satoshi Yasuda, lsao Morii, Hiroyuki Kakuchi, Yoritaka Otsuka, Atsushi Kawamura, Hiroshi Nonogi, Yoshikado Sasako, Shunichi Miyazaki, National Cardiovascular Center, Suita, Japan Background: The application of extracorporeal membrane oxygenation (ECMO) wtth percutaneous cardiopulmonary bypass has been recently extended to temporaiy circula- tory support in patients with fulminant myocarditis. However, the survival and prognosis of patients who are particularly ill remain poorly understood. Methods: Patients with myocarditis were divided into the following two groups. Fourteen patients who required ECMO for cardiogenic shock were defined as having fulminant myocarditis (F group), whereas 13 patients who had acute onset of symptoms but did not have compromised hemodynamics were defined as having acute (nonfulminant) myocarditis (non-F group). Results: In F group, 10 patients were successfully weaned from ECMO. Therefore, the overall survival rate at the time of discharge was 71%. Between patients who died (D) and those survived (S) in F group. there were significant differences (PcO.05) in left ven- tricular end-diastolic dimension (D:36& vs S:50*2 [mean&EM] mm), end-systolic dimension (D:34+6 vs S:45+2mm), wall thickness (D:15+1 vs S:l lilmm). maxCPK-MB levels (D:353*145 vs S:120+35U/L) and serum creatinine levels (D:2.1*0.5 vs S:l.O+O.lmg/dl). Compared with the non-F group, the fractional shortening in the F group was more severely depressed in the acute phase (F:lOil vs non-F:23*3%, Pfulminant myocarditis, a hemo- dynamic support using ECMO results in excellent swival. Once a patient recovers from inflammatory myocardial damage, the subsequent clinical outcome is favorable, similar to that observed in patients with acute (nonfulminant) myocardltis. 1208-66