Bak Minjung, Hyun Junho, Park Hyukjin, Kim Hyung Yoon, Lee Seonhwa, Kim In-Cheol, Kim So Ree, Kim Mi-Na, Kim Kyung-Hee, Yang Jeong Hoon
Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Division of Cardiology, Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Rev Esp Cardiol (Engl Ed). 2025 Mar;78(3):176-184. doi: 10.1016/j.rec.2024.06.004. Epub 2024 Jun 25.
Although venoarterial extracorporeal membrane oxygenation (VA-ECMO) provides effective cardiocirculatory support in patients with fulminant myocarditis, the most effective timing of venting is uncertain. We aimed to investigate the benefit of early venting among patients who underwent VA-ECMO for fulminant myocarditis.
Among 841 patients with acute myocarditis from 7 hospitals in the Republic of Korea, 217 patients with fulminant myocarditis who underwent VA-ECMO were included in this analysis. The patients were categorized into 2 groups: an early unloading group that underwent venting within 24hours of ECMO insertion, and the no or delayed unloading group. The primary outcome was a composite of death, cardiac replacement, or cardiovascular rehospitalization.
Among 217 patients, 56 underwent early venting, 54 underwent delayed venting, and 107 did not undergo venting. On spline curves in 110 patients who underwent venting, rapid deterioration was observed as the timing of venting was delayed. The incidence of the primary outcome was lower in the early venting group than in the no or delayed unloading group (37.5% vs 58.4%; HR, 0.491; 95%CI, 0.279-0.863; P=.014). Among patients not experiencing the primary outcome within 6 months, clinical outcomes were similar after 6 months (P=.375).
Early left heart unloading within 24hours of ECMO insertion is associated with a lower risk of a composite of death, cardiac replacement therapy, and cardiovascular rehospitalization in patients with fulminant myocarditis undergoing VA-ECMO. Registered at ClinicalTrials.gov (NCT05933902).
尽管静脉-动脉体外膜肺氧合（VA-ECMO）为暴发性心肌炎患者提供了有效的心肺循环支持，但最有效的排气时机尚不确定。我们旨在研究在接受VA-ECMO治疗的暴发性心肌炎患者中早期排气的益处。
在韩国7家医院的841例急性心肌炎患者中，217例接受VA-ECMO治疗的暴发性心肌炎患者纳入本分析。患者分为两组：早期减负组，在ECMO植入后24小时内进行排气；非减负或延迟减负组。主要结局是死亡、心脏置换或心血管再住院的复合结局。
217例患者中，56例早期排气，54例延迟排气，107例未排气。在110例接受排气的患者的样条曲线上，随着排气时间延迟，观察到快速恶化。早期排气组的主要结局发生率低于非减负或延迟减负组（37.5%对58.4%；HR，0.491；95%CI，0.279-0.863；P=0.014）。在6个月内未发生主要结局事件的患者中，6个月后的临床结局相似（P=0.375）。
对于接受VA-ECMO治疗的暴发性心肌炎患者，在ECMO植入后24小时内进行早期左心减负与死亡、心脏替代治疗和心血管再住院复合结局的风险较低相关。在ClinicalTrials.gov注册（NCT05933902）。
