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Clinical Outcomes in Pediatric Patients Hospitalized with Fulminant Myocarditis Requiring Extracorporeal Membrane Oxygenation: A Meta-analysis

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Abstract

We conducted a meta-analysis to provide the survival rates for pediatric patients hospitalized with fulminant myocarditis requiring ECMO. The literature search was conducted using Embase, PubMed, MEDLINE and Elsevier for studies published before April 1, 2016. We focus on survival rates for pediatric patients hospitalized with fulminant myocarditis requiring ECMO, and studies that reported only on adult patients were excluded. Summary of the survival rates was obtained using fixed-effect or random-effect meta-analysis which determined by I 2. Six studies were included in the analysis, encompassing 172 patients. The minimum and maximum reported rates of survival to hospital discharge were 53.8 and 83.3%, respectively. The cumulative rate was 107/172. The calculated Cochran Q value was 3.73, which was not significant for heterogeneity (P = 0.588). The I 2 value was 0%. The pooled estimate rate was 62.9% with a 95% confidence interval of 55.3–69.8%. In pediatric patients with cardiac failure who have failed conventional therapies in FM, venoarterial ECMO should be considered. In total, 62.9% of patients with FM and either cardiogenic shock and/or cardiac arrest survived to hospital discharge with ECMO.

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References

  1. McCarthy RR et al (2000) Long-term outcome of fulminant myocarditis as compared with acute (nonfulminant) myocarditis. N Engl J Med 342(10):690–695

    Article  PubMed  Google Scholar 

  2. Lieberman EB et al (1991) Clinicopathologic description of myocarditis. J Am Coll Cardiol 18(7):1617–1626

    Article  CAS  PubMed  Google Scholar 

  3. Nahum E et al (2010) Favorable outcome of pediatric fulminant myocarditis supported by extracorporeal membranous oxygenation. Pediatr Cardiol 31(7):1059–1063

    Article  PubMed  Google Scholar 

  4. Lee EY et al (2014) Clinical features and short-term outcomes of pediatric acute fulminant myocarditis in a single center. Korean J Pediatr 57(11):489–495

    Article  PubMed  PubMed Central  Google Scholar 

  5. Ghelani SJ et al (2012) Demographics, trends, and outcomes in pediatric acute myocarditis in the United States, 2006 to 2011. Circ Cardiovasc Qual Outcomes 5(5):622–627

    Article  PubMed  Google Scholar 

  6. Hsu KH et al (2011) Extracorporeal membranous oxygenation support for acute fulminant myocarditis: analysis of a single center’s experience. Eur J Cardiothorac Surg 40(3):682–688

    PubMed  Google Scholar 

  7. Teele SA et al (2011) Management and outcomes in pediatric patients presenting with acute fulminant myocarditis. J Pediatr 158(4):638–643.e1

    Article  PubMed  Google Scholar 

  8. Klugman D et al (2010) Pediatric patients hospitalized with myocarditis: a multi-institutional analysis. Pediatr Cardiol 31(2):222–228

    Article  PubMed  Google Scholar 

  9. Wren C, O’Sullivan JJ, Wright C (2000) Sudden death in children and adolescents. Heart 83(4):410–413

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Aretz HT (1987) Myocarditis: the Dallas criteria. Hum Pathol 18(6):619–624

    Article  CAS  PubMed  Google Scholar 

  11. Baughman KL (2006) Diagnosis of myocarditis: death of Dallas criteria. Circulation 113(4):593–595

    Article  PubMed  Google Scholar 

  12. Kindermann I et al (2008) Predictors of outcome in patients with suspected myocarditis. Circulation 118(6):639–648

    Article  PubMed  Google Scholar 

  13. Robinson JL et al (2005) A systematic review of intravenous gamma globulin for therapy of acute myocarditis. BMC Cardiovasc Disord 5(1):12

    Article  PubMed  PubMed Central  Google Scholar 

  14. Aziz KU et al (2010) Acute viral myocarditis: role of immunosuppression: a prospective randomised study. Cardiol Young 20(5):509–515

    Article  PubMed  Google Scholar 

  15. Lee KJ et al (1999) Clinical outcomes of acute myocarditis in childhood. Heart 82(2):226–233

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Wilmot I et al (2011) Effectiveness of mechanical circulatory support in children with acute fulminant and persistent myocarditis. J Card Fail 17(6):487–494

    Article  PubMed  Google Scholar 

  17. Stiller B (2008) Management of myocarditis in children: the current situation. Adv Exp Med Biol 609:196–215

    Article  PubMed  Google Scholar 

  18. Kato S et al (2004) Risk factors for patients developing a fulminant course with acute myocarditis. Circ J 68(8):734–739

    Article  PubMed  Google Scholar 

  19. Wu ET et al (2006) Children with fulminant myocarditis rescued with extracorporeal membrane oxygenation. Heart 92(9):1325–1326

    Article  PubMed  PubMed Central  Google Scholar 

  20. Almond CS et al (2011) Extracorporeal membrane oxygenation for bridge to heart transplantation among children in the United States: analysis of data from the Organ Procurement and Transplant Network and Extracorporeal Life Support Organization Registry. Circulation 123(25):2975–2984

    Article  PubMed  Google Scholar 

  21. Cheng R et al (2014) Complications of extracorporeal membrane oxygenation for treatment of cardiogenic shock and cardiac arrest: a meta-analysis of 1,866 adult patients. Ann Thorac Surg 97(2):610–616

    Article  PubMed  Google Scholar 

  22. Foley PJ et al (2010) Limb ischemia during femoral cannulation for cardiopulmonary support. J Vasc Surg 52(4):850–853

    Article  PubMed  Google Scholar 

  23. Bisdas T et al (2011) Vascular complications in patients undergoing femoral cannulation for extracorporeal membrane oxygenation support. Ann Thorac Surg 92(2):626–631

    Article  PubMed  Google Scholar 

  24. Ning B et al (2013) Local experience with extracorporeal membrane oxygenation in children with acute fulminant myocarditis. PLoS ONE 8(12):e82258

    Article  PubMed  PubMed Central  Google Scholar 

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Correspondence to Wenqi Huang.

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Xiong, H., Xia, B., Zhu, J. et al. Clinical Outcomes in Pediatric Patients Hospitalized with Fulminant Myocarditis Requiring Extracorporeal Membrane Oxygenation: A Meta-analysis. Pediatr Cardiol 38, 209–214 (2017). https://doi.org/10.1007/s00246-016-1517-1

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  • DOI: https://doi.org/10.1007/s00246-016-1517-1

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