Extracorporeal Membrane Oxygenation Cannulation Timing in the Pediatric Myocarditis Population: An Exploratory Analysis From the Extracorporeal Life Support Organization Registry

Authors

Maria E Gutierrez
Marc Anders
Danielle Guffey
Susan W Denfield
Shriprasad R Deshpande
Satish K Rajagopal
Ravi R Thiagarajan
Peta M A Alexander
Javier J Lasa

Publication Date

1-1-2023

Journal

Critical Care Explorations

DOI

10.1097/CCE.0000000000000826

PMID

36619364

PMCID

PMC9810122

PubMedCentral® Posted Date

12-30-2022

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes

Keywords

acute myocarditis, cardiac arrest, extracorporeal membrane oxygenation, pediatric myocarditis

Abstract

Children presenting with acute myocarditis may experience rapid clinical deterioration requiring extracorporeal membrane oxygenation (ECMO); however, our understanding of best practices and timing of ECMO initiation are lacking. We explored the relationships between pre-cannulation factors and survival in this high-acuity patient population.

DESIGN: Retrospective review of a large international registry. Primary outcome was survival to hospital discharge, stratified by incident cardiac arrest (CA) prior to ECMO and time to cannulation after intubation.

SETTING AND SUBJECTS: The Extracorporeal Life Support Organization registry was queried for patients less than or equal to 18 years old receiving ECMO support for myocarditis between 2007 and 2018. Exclusion criteria included being nonindex runs, non-venoarterial ECMO or missing data points for main variables studied.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN RESULTS: Population characteristics and survival were compared using

CONCLUSIONS: The results of this multicenter analysis of ECMO utilization and outcomes for pediatric myocarditis suggest that patients approaching ECMO cannulation who have not experienced CA may have better survival outcomes if cannulated onto ECMO early after intubation.