Clinical Outcomes in Fulminant Myocarditis Requiring Extracorporeal Membrane Oxygenation: A Weighted Meta-Analysis of 170 Patients |
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| Institution: | 1. Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY;2. Division of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY;3. Veterans Affairs Medical Center, George Washington University, and Georgetown University, Washington, DC;4. Ahmanson-UCLA Cardiomyopathy Center, Division of Cardiology, University of California, Los Angeles, CA;1. Department of Aerospace Engineering, University of Michigan, Ann Arbor, MI 48109, USA;2. Department of Mechanical and Aerospace Engineering, Princeton University, Princeton, NJ 08544, USA;3. German Aerospace Center (DLR) Institution of Combustion Technology, Pfaffenwaldring 38–40, D-70569, Stuttgart, Germany |
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| Abstract: | BackgroundFulminant myocarditis (FM) is often a self-resolving entity if the patient survives the acute illness. Venoarterial extracorporeal membrane oxygenation (ECMO) has been used successfully for treatment of cardiogenic shock or cardiac arrest due to FM. However, clinical outcomes are not well understood, in part because of small study sizes. In the absence of large clinical trials, performance of pooled analysis represents the best method for ascertaining survival rates for ECMO.MethodsA systematic Medline search was conducted on ECMO for the treatment of FM, updated up to November 2012. Studies with n ≥10 published in the year 2000 or later that reported survival to hospital discharge for FM requiring ECMO were included. Studies that reported only on pediatric patients were excluded. The smaller of studies with overlapping patients were excluded. Cochran Q and I2 were calculated and reported.ResultsSix studies were included in the analysis, encompassing 170 patients. The minimum and maximum reported rates of survival to hospital discharge were 60.0% and 87.5%, respectively. The cumulative rate was 115/170. The calculated Cochran Q value was 3.63, which was not significant for heterogeneity. The I2 value was 0%. The pooled estimate rate was 66.9% with a 95% confidence interval of 59.4%–73.7%.ConclusionMore than two-thirds of patients with FM and either cardiogenic shock and/or cardiac arrest survive to hospital discharge with ECMO. These findings could be used in the risk-benefit analysis when initiation of a cardiopulmonary bypass system is being considered for FM. |
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| Keywords: | Heart failure circulatory assistance cardiogenic shock cardiac |
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