Kamsheh Alicia M, Edelson Jonathan B, Faerber Jennifer, Mondal Antara, Quarshie William, Edwards Jonathan J, Lin Kimberly Y, O'Connor Matthew J, Wittlieb-Weber Carol, Maeda Katsuhide, Goldsmith Michael P, Rossano Joseph W
Division of Pediatric Cardiology, Washington University School of Medicine, St. Louis, MO.
Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA.
JHLT Open. 2024 Feb;3. doi: 10.1016/j.jhlto.2023.100026. Epub 2023 Nov 23.
Myocarditis is a common cause of pediatric heart failure which may require mechanical circulatory support (MCS). The purpose of this study is to describe MCS strategies used in a nationwide cohort of pediatric patients with myocarditis, identify trends over time, and compare outcomes between MCS strategies.
This study utilized the Kids' Inpatient Database (KID), a national sample of administrative discharge data. KID admissions from 2003-2016 were queried using ICD-9/10 codes to identify those with a diagnosis of myocarditis. MCS outcomes were compared using logistic regression.
Of 5,661 admissions for myocarditis, MCS was used in 424 (7.5%), comprised of extracorporeal membrane oxygenation (ECMO) in 312 (73.6%), including 32 (10.2%) instances of extracorporeal cardiopulmonary resuscitation (ECPR), temporary ventricular assist devices (tVAD) in 28 (6.6%), durable VAD (dVAD) in 42 (9.9%) and combination MCS in 42 (9.9%). MCS use increased over time (p=0.031), but MCS strategies did not significantly change. Mortality was high in the MCS group (28.3%). There was no difference in odds of death in the VAD only or combination MCS group compared to the non-ECPR ECMO group (p=0.07 and p=0.65, respectively).
MCS is used in 1 in 13 pediatric myocarditis cases, and MCS use is increasing over time with ECMO remaining the most frequently used modality. Mortality remains high in patients that receive MCS but does not differ between those receiving VAD or combination MCS as compared to non-ECPR ECMO on unadjusted analysis. Further prospective analysis is required to evaluate the relative effectiveness of MCS modalities in this disease.
心肌炎是小儿心力衰竭的常见病因，可能需要机械循环支持（MCS）。本研究的目的是描述全国范围内小儿心肌炎患者使用的MCS策略，确定随时间的趋势，并比较MCS策略之间的结果。
本研究使用了儿童住院数据库（KID），这是一个全国性的行政出院数据样本。使用ICD-9/10编码查询2003年至2016年KID的入院病例，以识别诊断为心肌炎的患者。使用逻辑回归比较MCS结果。
在5661例心肌炎入院病例中，424例（7.5%）使用了MCS，其中312例（73.6%）采用体外膜肺氧合（ECMO），包括32例（10.2%）体外心肺复苏（ECPR），28例（6.6%）使用临时心室辅助装置（tVAD），42例（9.9%）使用持久心室辅助装置（dVAD），42例（9.9%）采用联合MCS。MCS的使用随时间增加（p=0.031），但MCS策略没有显著变化。MCS组的死亡率很高（28.3%）。仅使用VAD或联合MCS组与非ECPR ECMO组相比，死亡几率没有差异（分别为p=0.07和p=0.65）。
每13例小儿心肌炎病例中有1例使用MCS，且随着时间的推移，MCS的使用在增加，ECMO仍然是最常用的方式。接受MCS的患者死亡率仍然很高，但在未调整分析中，接受VAD或联合MCS的患者与非ECPR ECMO的患者相比，死亡率没有差异。需要进一步的前瞻性分析来评估MCS模式在这种疾病中的相对有效性。
