Abstract 2155: Outcome Following Admission to Cardiac Intensive Care Unit in Pediatric Patients With Acute Fulminant Myocarditis
Background: Acute fulminant myocarditis (AFM) is an aggressive form of myocarditis that can be life-threatening. Despite the severity of illness, patients (pts) who are adequately supported have a high rate of survival and recovery of native cardiac function. Knowledge of factors associated with need for mechanical support and survival could aid in pt triage to centers that can provide mechanical support and heart transplantation services.
Methods: Retrospective cohort study of pts with AFM admitted to the Cardiac Intensive Care Unit at Children’s Hospital Boston during 1996 – 2008. AFM was defined as: distinct onset of symptoms ≤14 days prior to admission, rapid hemodynamic compromise, normal left ventricular size, and myocardial dysfunction. We compared demographic details and physiological variables at admission and hospitalization, between pts who received extracorporeal membrane oxygenation (ECMO) and those who did not, and survivors and non-survivors. The Mann-Whitney U test was used for continuous variables and Fisher’s exact test for analysis of categorical variables.
Results: Twenty pts (median age 12.7 years) met inclusion criteria. Myocarditis was confirmed by biopsy in 16 (88%) of whom 14 (88%) had both inflammatory cells and myocyte necrosis. Overall survival to discharge was 17 (85%), and 14 (82%) recovered normal native heart function. Ten (50%) pts required mechanical support with ECMO and 7 (70%) of these pts survived to hospital discharge. Pts requiring ECMO had elevated serum lactate (9 vs. 1 mmol/L), creatinine (0.8 vs. 0.6 mg/dL), and aspartate transaminase (AST) (256 vs. 35 IU/L) (all p values <0.05) on admission, and a trend towards increased incidence of dysrhythmias (100% vs. 60%, p= 0.09) during admission. Non-survivors had significantly higher peak serum lactate (10 vs. 3 mmol/L), creatinine (1.5 vs. 0.8 mg/dL), and AST (3007 vs. 156 IU/L) (all p values <0.05) compared with survivors. One (5%) pt received OHT.
Conclusion: Transplant-free survival in this cohort was excellent (80%) despite the need for ECMO in 50% of the pts. Presence of end organ dysfunction at admission and during hospitalization was associated with ECMO use and mortality, and may indicate need for transfer to a tertiary care center.