PMID- 37345545
OWN - NLM
STAT- MEDLINE
DCOM- 20230721
LR  - 20230723
IS  - 1941-3297 (Electronic)
IS  - 1941-3289 (Linking)
VI  - 16
IP  - 7
DP  - 2023 Jul
TI  - Outcomes With Peripheral Venoarterial Extracorporeal Membrane Oxygenation for 
      Suspected Acute Myocarditis: 10-Year Experience From the Extracorporeal Life 
      Support Organization Registry.
PG  - e010152
LID - 10.1161/CIRCHEARTFAILURE.122.010152 [doi]
AB  - BACKGROUND: Acute myocarditis can result in severe hemodynamic compromise 
      requiring venoarterial extracorporeal membrane oxygenation (VA-ECMO). Outcomes 
      and factors associated with mortality among myocarditis patients are not well 
      described in the modern ECMO era. METHODS: We queried the Extracorporeal Life 
      Support Organization registry from 2011 to 2020 for adults with suspected acute 
      myocarditis undergoing peripheral VA-ECMO support. The primary outcome was 
      in-hospital mortality and was compared to all-comers receiving VA-ECMO in the 
      registry over the same period. Secondary outcomes were rates of bridging to 
      advanced therapies and ECMO complications. We used multivariable logistic 
      regression to examine factors associated with in-hospital mortality. RESULTS: 
      Among 850 patients with suspected acute myocarditis receiving peripheral VA-ECMO, 
      the mean age was 41 years, 52% were men, 39% Asian race, and 14.8% underwent 
      extracorporeal cardiopulmonary resuscitation. During the study period, 
      in-hospital mortality steadily declined and was 58.3% for all all-comers 
      receiving VA-ECMO compared with 34.9% for patients with myocarditis (P<0.001). 
      After multivariable modeling, risk factors for mortality were earlier year of 
      support, older age, higher weight, Asian race, need for extracorporeal 
      cardiopulmonary resuscitation, sepsis, and lower mean arterial pressure and pH 
      prior to ECMO initiation. ECMO complications including bleeding, limb ischemia, 
      infections and ischemic stroke were more common among nonsurvivors and 
      significantly declined during the study period. CONCLUSIONS: Compared with 
      all-comers supported with VA-ECMO, in-hospital mortality for patients with acute 
      myocarditis is significantly lower, with nearly two-thirds of patients surviving 
      to discharge. Major modifiable risk factors for mortality were ongoing 
      cardiopulmonary resuscitation requiring ECMO and markers of illness severity 
      prior to ECMO.
FAU - Nunez, Jose I
AU  - Nunez JI
AUID- ORCID: 0000-0003-4293-0129
AD  - Department of Internal Medicine, Montefiore Medical Center, Albert Einstein 
      College of Medicine, Bronx, NY (J.I.N.).
FAU - Grandin, E Wilson
AU  - Grandin EW
AUID- ORCID: 0000-0002-4287-334X
AD  - Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, 
      Boston, MA (E.W.G., T.R.-C., M.S., P.Q., S.M., L.M.F., R.S., J.E.H., A.R.G.).
AD  - Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical 
      Center, Boston, MA (E.W.G., K.K.).
FAU - Reyes-Castro, Tiago
AU  - Reyes-Castro T
AUID- ORCID: 0000-0001-7329-3375
AD  - Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, 
      Boston, MA (E.W.G., T.R.-C., M.S., P.Q., S.M., L.M.F., R.S., J.E.H., A.R.G.).
FAU - Sabe, Marwa
AU  - Sabe M
AD  - Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, 
      Boston, MA (E.W.G., T.R.-C., M.S., P.Q., S.M., L.M.F., R.S., J.E.H., A.R.G.).
FAU - Quintero, Pablo
AU  - Quintero P
AUID- ORCID: 0000-0001-9423-5676
AD  - Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, 
      Boston, MA (E.W.G., T.R.-C., M.S., P.Q., S.M., L.M.F., R.S., J.E.H., A.R.G.).
FAU - Motiwala, Shweta
AU  - Motiwala S
AD  - Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, 
      Boston, MA (E.W.G., T.R.-C., M.S., P.Q., S.M., L.M.F., R.S., J.E.H., A.R.G.).
FAU - Fleming, Lisa M
AU  - Fleming LM
AD  - Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, 
      Boston, MA (E.W.G., T.R.-C., M.S., P.Q., S.M., L.M.F., R.S., J.E.H., A.R.G.).
FAU - Sriwattanakomen, Roy
AU  - Sriwattanakomen R
AD  - Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, 
      Boston, MA (E.W.G., T.R.-C., M.S., P.Q., S.M., L.M.F., R.S., J.E.H., A.R.G.).
FAU - Ho, Jennifer E
AU  - Ho JE
AUID- ORCID: 0000-0002-7987-4768
AD  - Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, 
      Boston, MA (E.W.G., T.R.-C., M.S., P.Q., S.M., L.M.F., R.S., J.E.H., A.R.G.).
FAU - Kennedy, Kevin
AU  - Kennedy K
AD  - Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical 
      Center, Boston, MA (E.W.G., K.K.).
FAU - Tonna, Joseph E
AU  - Tonna JE
AUID- ORCID: 0000-0001-8879-2628
AD  - Extracorporeal Life Support Organization, Ann Arbor, MI (J.E.T.).
AD  - Division of Cardiothoracic Surgery and Emergency Medicine, University of Utah, 
      Salt Lake City (J.E.T.).
FAU - Garan, A Reshad
AU  - Garan AR
AUID- ORCID: 0000-0001-7510-075X
AD  - Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, 
      Boston, MA (E.W.G., T.R.-C., M.S., P.Q., S.M., L.M.F., R.S., J.E.H., A.R.G.).
LA  - eng
PT  - Comment
PT  - Journal Article
DEP - 20230622
PL  - United States
TA  - Circ Heart Fail
JT  - Circulation. Heart failure
JID - 101479941
SB  - IM
CON - Circ Heart Fail. 2020 Nov;13(11):e007405. PMID: 33176455
CIN - Circ Heart Fail. 2023 Jul;16(7):e010670. PMID: 37345549
MH  - Male
MH  - Adult
MH  - Humans
MH  - Female
MH  - *Extracorporeal Membrane Oxygenation/adverse effects
MH  - *Myocarditis/therapy/complications
MH  - *Heart Failure/therapy
MH  - Risk Factors
MH  - Registries
MH  - Retrospective Studies
MH  - Shock, Cardiogenic/etiology
OTO - NOTNLM
OT  - cardiopulmonary resuscitation
OT  - extracorporeal membrane oxygenation
OT  - myocarditis
OT  - risk factor
COIS- Disclosures Dr Garan has received research support from Abbott Vascular and 
      Verantos and is a consultant for Abiomed and NupulseCV. Dr Ho has received 
      research support from Bayer AG. The other authors report no conflicts.
EDAT- 2023/06/22 06:42
MHDA- 2023/07/21 06:42
CRDT- 2023/06/22 05:32
PHST- 2023/07/21 06:42 [medline]
PHST- 2023/06/22 06:42 [pubmed]
PHST- 2023/06/22 05:32 [entrez]
AID - 10.1161/CIRCHEARTFAILURE.122.010152 [doi]
PST - ppublish
SO  - Circ Heart Fail. 2023 Jul;16(7):e010152. doi: 
      10.1161/CIRCHEARTFAILURE.122.010152. Epub 2023 Jun 22.