The Saviour of a Pregnant Woman With Fulminant Myocarditis ——Extracorporeal Membrane Oxygenation: A Case Report

Abstract INTRODUCTION: There are no reports regarding a pregnant woman with fulminant myocarditis underwent Extracorporeal Membrane Oxygenation (ECMO). Hence, we report a case of successful ECMO treatment of fulminant myocarditis puerpera. CASE PRESENTATION: A 32-year-old puerpera was admitted to our hospital with menopause for 7 months, fetal movement for 3 months and fever for 1 day. After admission, the patient's body temperature increased repeatedly, heart rate increased, and the whole process C-reactive protein increased rapidly. Considered a diagnosis of fulminant myocarditis. After antiviral and cardioprotective treatment, the heart function progressively worsened. Pregnancy was terminated, the newborn was intubated in the neonatal room for rescue after surgery, and ECMO treatment was given after the puerpera was transferred to the intensive care unit. Finally, the patient and the baby have been safely discharged from hospital. DISCUSSION: ECMO can provide cardiac and respiratory support. Fulminant myocarditis is common in children, adolescents and particularly pregnant women who had the highest mortality rate. In the pregnant woman with fulminant myocarditis described in this report, antiviral treatment only transiently improved heart function and then heart function progressively worsened. After receiving ECMO therapy, the patient's cardiac function has improved markedly. The patient was then successfully weaned from ECMO. To our knowledge, this is the first report of pregnant woman in whom ECMO was part of the treatment for fulminant myocarditis. CONCLUSION: We report a case of successful ECMO treatment of fulminant myocarditis puerpera. ECMO can be the treatment of choice for pregnant women with fulminant myocarditis.

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Interleukin-6 may predict survival in extracorporeal membrane oxygenation treatment

Perfusion ◽

10.1177/0267659108097882 ◽

2008 ◽

Vol 23 (3) ◽

pp. 173-178 ◽

Cited By ~ 31

Author(s):

I Risnes ◽

K Wagner ◽

T Ueland ◽

TE Mollnes ◽

P Aukrust ◽

...

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Complement Activation ◽

Statistical Significance ◽

Cytokine Network ◽

Prognostic Information ◽

Reactive Protein ◽

Membrane Oxygenation ◽

Pulmonary Failure ◽

Ecmo Treatment ◽

Observation Period

The cytokine network and its association with complement activation during cardiac surgery with cardiopulmonary bypass (CPB) is complex. Extracorporeal membrane oxygenation (ECMO) differs from CPB in duration of days to weeks rather than hours. However, few studies have analyzed the levels of inflammatory mediators during ECMO treatment. Plasma samples from 22 patients [nine neonates, one infant, four children and eight adults (14 males and eight female)] who underwent ECMO treatment were collected prior to, during and after treatment, and analyzed for concentrations of inflammatory and anti-inflammatory cytokines and parameters of complement activation. Seven children were treated for cardiac and seven for pulmonary failure and, in the adult group, four were treated for cardiac and four for pulmonary failure. ECMO was performed with veno-arterial (VA) bypass in all children and five adults, and with veno-venous (VV) bypass in three adults. Fourteen patients survived (64%) and eight (36%) patients died during follow-up. A marked (~99%) and rapid (i.e., within two days) decrease in IL-6 was seen in survivors. The non-survivors were characterized by persistently high IL-6 levels throughout the observation period (i.e., until death). C-reactive protein (CRP) levels showed a similar pattern as the IL-6, with higher levels in non-survivors throughout the observation period. However, in contrast to IL-6, the differences between survivors and non-survivors reached statistical significance, but only at the end of the observation period. It is possible that early measurements of IL-6 in ECMO patients could give prognostic information beyond that of CRP.

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Fulminant myocarditis: use of echocardiography from diagnosis to extracorporeal membrane oxygenation

Echo Research and Practice ◽

10.1530/erp-20-0005 ◽

2020 ◽

Vol 7 (3) ◽

pp. K21-K26

Author(s):

Na Hyun Park ◽

Hazem Lashin ◽

Rosalba Spiritoso

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Early Recognition ◽

Heart Function ◽

Thrombus Formation ◽

Fulminant Myocarditis ◽

High Dose ◽

List Type ◽

Membrane Oxygenation ◽

Threatening Condition ◽

Life Threatening

Summary Fulminant myocarditis can present with life-threatening arrhythmias and cardiogenic shock due to ventricular failure. The diagnosis of myocarditis usually requires histological and immunological information, as its aetiology may be infectious (viral or non-viral), autoimmune or drug related. The treatment of fulminant myocarditis depends on the underlying cause but usually includes high dose systemic steroids as well as physiological support. Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) can be used to support patients as a bridge to recovery by supporting biventricular function and decompressing the heart. V-A ECMO carries risks and complications of its own such as thrombus formation or bleeding. Different diagnostic modalities, such as transthoracic echocardiogram (TTE) and transoesophageal echocardiogram (TOE), are central to the monitoring of progression of disease and recovery of heart function. This case highlights the importance of early recognition and early support with V-A ECMO in fulminant myocarditis, as well as the role of repeated echocardiography when weaning from physiological support. Learning points: Myocarditis is a life-threatening condition and early recognition of cardiac failure can be assisted with a bedside echocardiogram. Extracorporeal membrane oxygenation is used as a bridging method of treatment for patients with cardiogenic failure in myocarditis but has its own risks related to anticoagulation and the procedure itself. There are currently no standardised guidelines of when to wean a patient off extracorporeal membrane oxygenation, but echocardiography acts as an important guide to detect complications as well as cardiac recovery.

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Kinetics of Procalcitonin in Pediatric Patients on Extracorporeal Membrane Oxygenation

Biomarker Insights ◽

10.1177/1177271917751900 ◽

2018 ◽

Vol 13 ◽

pp. 117727191775190 ◽

Cited By ~ 5

Author(s):

Sara Bobillo ◽

Javier Rodríguez-Fanjul ◽

Anna Solé ◽

Julio Moreno ◽

Mònica Balaguer ◽

...

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Prospective Observational Study ◽

Pediatric Patients ◽

Clinical Situation ◽

Multiple Organ ◽

C Reactive Protein ◽

Reactive Protein ◽

Membrane Oxygenation ◽

Neurologic Sequelae ◽

Kinetics Of

Objectives: To assess the kinetics of procalcitonin (PCT) and C-reactive protein (CRP) in pediatric patients who required extracorporeal membrane oxygenation (ECMO) and to analyze its relationship with morbidity and mortality. Patients and methods: Prospective observational study including pediatric patients who required ECMO. Both PCT and CRP were sequentially drawn before ECMO (P0) and until 72 hours after ECMO. Results: A total of 40 patients were recruited. Two cohorts were established based on the value of the P0 PCT (>10 ng/mL). Comparing the kinetics of PCT and CRP in these cohorts, the described curves were the expected for each clinical situation. The cutoff for P0 PCT to predict multiple organ dysfunction syndrome was 2.55 ng/mL (sensibility 83%, specificity 100%). Both PCT and CRP did not predict risk of neurologic sequelae or mortality in any group. Conclusions: Procalcitonin does not seem to be modified by ECMO and could be a good biomarker of evolution.

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Mid-term survival of patients with chronic kidney disease after extracorporeal membrane oxygenation

Interactive CardioVascular and Thoracic Surgery ◽

10.1093/icvts/ivaa168 ◽

2020 ◽

Vol 31 (5) ◽

pp. 595-602

Author(s):

Yueh-An Lu ◽

Shao-Wei Chen ◽

Cheng-Chia Lee ◽

Victor Chien-Chia Wu ◽

Pei-Chun Fan ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Mortality Rate ◽

Extracorporeal Membrane Oxygenation ◽

Hospital Mortality ◽

Subgroup Analysis ◽

Mortality Rates ◽

Term Survival ◽

Membrane Oxygenation ◽

Ecmo Treatment

Abstract OBJECTIVES Chronic kidney disease (CKD) impairs the elimination of fluids, electrolytes and metabolic wastes, which can affect the outcomes of extracorporeal membrane oxygenation (ECMO) treatment. This study aimed to elucidate the impact of CKD on in-hospital mortality and mid-term survival of adult patients who received ECMO treatment. METHODS Patients who received first-time ECMO treatment between 1 January 2003 and 31 December 2013 were included. Those with CKD were identified and matched to patients without CKD using a 1:2 ratio and were followed for 3 years. The study outcomes included in-hospital outcomes and the 3-year mortality rate. A subgroup analysis was conducted by comparing the dialytic patients with the non-dialytic CKD patients. RESULTS The study comprised 1008 CKD patients and 2016 non-CKD patients after propensity score matching. The CKD patients had higher in-hospital mortality rates [69.5% vs 62.2%; adjusted odds ratio 1.41; 95% confidence interval (CI) 1.15–1.72] than the non-CKD patients. The 3-year mortality rate was 80.4% in the CKD group and 68% in the non-CKD group (adjusted hazard ratio 1.17; 95% CI 1.06–1.28). The subgroup analysis showed that the 3-year mortality rates were 84.5% and 78.4% in the dialytic and non-dialytic patients, respectively. No difference in the 3-year mortality rate was noted between the 2 CKD subgroups (P = 0.111). CONCLUSIONS CKD was associated with increased risks of in-hospital and mid-term mortalities in patients who received ECMO treatment. Furthermore, no difference in survival was observed between the patients with end-stage renal disease and non-dialytic CKD patients.

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GW26-e0087 Therapeutic Value of Extracorporeal Membrane Oxygenation in Acute Fulminant Myocarditis: An Observational Study

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2015.06.1062 ◽

2015 ◽

Vol 66 (16) ◽

pp. C273

Author(s):

Changzhi Liu ◽

Jingcheng Lin ◽

Mao Liu ◽

Dezhu Chen ◽

Ruiqiu Zhu ◽

...

Keyword(s):

Observational Study ◽

Extracorporeal Membrane Oxygenation ◽

Fulminant Myocarditis ◽

Membrane Oxygenation ◽

Therapeutic Value

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43-NEUROPSYCHIATRIC OUTCOME AFTER EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO) TREATMENT

Journal of Psychosomatic Research ◽

10.1016/j.jpsychores.2004.04.049 ◽

2004 ◽

Vol 56 (6) ◽

pp. 575

Author(s):

I Risnes ◽

J Jensen ◽

IJ Hynås ◽

A Heldal ◽

J Svennevig ◽

...

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Membrane Oxygenation ◽

Ecmo Treatment ◽

Neuropsychiatric Outcome

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Population Pharmacokinetics of Meropenem in Plasma and Subcutis from Patients on Extracorporeal Membrane Oxygenation Treatment

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.02390-17 ◽

2018 ◽

Vol 62 (5) ◽

Cited By ~ 9

Author(s):

Pelle Hanberg ◽

Kristina Öbrink-Hansen ◽

Anders Thorsted ◽

Mats Bue ◽

Mikkel Tøttrup ◽

...

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Continuous Infusion ◽

Prospective Observational Study ◽

Plasma Concentrations ◽

Content Type ◽

Membrane Oxygenation ◽

Population Pk ◽

Dosing Regimens ◽

Subcutaneous Adipose ◽

Ecmo Treatment

ABSTRACTThe objectives of this study were to describe meropenem pharmacokinetics (PK) in plasma and/or subcutaneous adipose tissue (SCT) in critically ill patients receiving extracorporeal membrane oxygenation (ECMO) treatment and to develop a population PK model to simulate alternative dosing regimens and modes of administration. We conducted a prospective observational study. Ten patients on ECMO treatment received meropenem (1 or 2 g) intravenously over 5 min every 8 h. Serial SCT concentrations were determined using microdialysis and compared with plasma concentrations. A population PK model of SCT and plasma data was developed using NONMEM. Time above clinical breakpoint MIC forPseudomonas aeruginosa(8 mg/liter) was predicted for each patient. The following targets were evaluated: time for which the free (unbound) concentration is maintained above the MIC of at least 40% (40%fT>MIC), 100%fT>MIC, and 100%fT>4×MIC. For all dosing regimens simulated in both plasma and SCT, 40%fT>MIC was attained. However, prolonged meropenem infusion would be needed for 100%fT>MIC and 100%fT>4×MIC to be obtained. Meropenem plasma and SCT concentrations were associated with estimated creatinine clearance (eCLCr). Simulations showed that in patients with increased eCLCr, dose increment or continuous infusion may be needed to obtain therapeutic meropenem concentrations. In conclusion, our results show that using traditional targets of 40%fT>MIC for standard meropenem dosing of 1 g intravenously every 8 h is likely to provide sufficient meropenem concentration to treat the problematic pathogenP. aeruginosafor patients receiving ECMO treatment. However, for patients with an increased eCLCr, or if more aggressive targets, like 100%fT>MIC or 100%fT>4×MIC, are adopted, incremental dosing or continuous infusion may be needed.

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Weaning adult patients with cardiogenic shock on veno-arterial extracorporeal membrane oxygenation by pump-controlled retrograde trial off

Perfusion ◽

10.1177/0267659118755888 ◽

2018 ◽

Vol 33 (5) ◽

pp. 339-345 ◽

Cited By ~ 10

Author(s):

Lowell Ling ◽

Kai Man Chan

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Cardiac Failure ◽

Heart Function ◽

Right Heart Failure ◽

Adult Patients ◽

Conventional Group ◽

Right Heart ◽

Membrane Oxygenation ◽

Tertiary Teaching ◽

Va Ecmo

Background: There is a lack of consensus on the timing of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) liberation. VA-ECMO weaning usually consists of serial decrements until an idling flow is achieved, supported by echocardiographic and haemodynamic assessments. Even with minimal idling flow, right ventricular (RV) preload is reduced and, hence, right heart function is not fully tested under adequate loading conditions. Following the use of a novel technique called Pump Controlled Retrograde Trial Off (PCRTO) in neonate VA-ECMO weaning, we report the use of this technique in seven adult patients on VA-ECMO. Methods: We retrospectively reviewed all adult VA-ECMO patients treated at a tertiary teaching hospital in Hong Kong since 2010. Clinical data, including diagnosis, echocardiography findings, ECMO configuration, PCRTO settings, survival after veno-arterial ECMO (SAVE) score and outcomes, were collected. Mortality and death due to cardiac failure was compared between PCRTO and conventional weaning. Results: Seven patients underwent PCRTO, with a mean SAVE score of -4.4 ± 5.9. All seven patients were successfully decannulated without haemodynamic deterioration. In all cases, no clots or fibrin deposits were found in the circuit after the trial. There was no difference in mean SAVE scores among the seven patients in PCRTO and the 23 patients in the conventional group (-3.6, 95% CI -8.8 to 1.5). The number of deaths due to cardiac failure in the PCRTO group and the conventional group were 0 and 3, respectively (0% vs. 13%, p=0.99). Mortality after decannulation for PCRTO was 42.9% vs. conventional weaning 34.8% (p=0.99). Conclusion: Our study suggests that PCRTO is a simple, safe and reversible alternative weaning method. It may have a particular role in the assessment of patients who have marginal recovery and right heart failure. Prospective controlled studies are needed to establish the potential role of PCRTO in the liberation of patients from VA-ECMO support.

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Respiratory Syncytial Virus Associated Myocarditis Requiring Venoarterial Extracorporeal Membrane Oxygenation

Case Reports in Infectious Diseases ◽

10.1155/2017/7074508 ◽

2017 ◽

Vol 2017 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

Anamaria Milas ◽

Aditya Shah ◽

Neesha Anand ◽

Meghan Saunders-Kurban ◽

Samir Patel

Keyword(s):

Respiratory Syncytial Virus ◽

Extracorporeal Membrane Oxygenation ◽

Fulminant Myocarditis ◽

Membrane Oxygenation ◽

Venoarterial Extracorporeal Membrane Oxygenation ◽

Threatening Condition ◽

Life Threatening ◽

Rsv Infection ◽

Syncytial Virus ◽

Va Ecmo

Severe fulminant myocarditis causing cardiogenic shock can be a rapidly progressing, life threatening condition. Respiratory syncytial virus (RSV) is a very rare infectious culprit infrequently described in medical literature as a cause of myocarditis, particularly in adults. We present a case of acute fulminant myocarditis in a patient with PCR positive RSV infection requiring venoarterial extracorporeal membrane oxygenation (VA-ECMO).

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