Dean Yomna E, Doma Mohamed, Afzal Ahson, Elawady Sameh Samir, Elmezayen Rafeek W, Bamousa Bdoor Ahmed A, Iqbal Naila, Megiso Muluken Zeleke, Kodurum Sriharsha, Ramadan Adham, El Bahaie Mahmoud, Magdi Ahmed, Afzal Fatima, Badr Helmy, Katamesh Basant, Ismail Dina, Etman Yasser, Hazimeh Yusef, Darling Edward, Aiash Hani
Faculty of Medicine, Alexandria University, Egypt.
Dow Medical College, Karachi, Pakistan.
Ann Med Surg (Lond). 2024 Oct 16;86(12):7049-7061. doi: 10.1097/MS9.0000000000002636. eCollection 2024 Dec.
Fulminant myocarditis (FM) is a potentially life-threatening disease that requires emergency care. The authors' study aims to explore clinical outcomes and predictors of survival when using veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support for the treatment of FM in adult and pediatric patients to analyze differences between both populations.
PubMed, Scopus, Web of Science, and Cochrane databases were searched for studies reporting the effect of VA-ECMO on patients diagnosed with fulminant myocarditis. Statistical analysis was performed using R version 4.2.2.
Forty-three studies were included in our analysis with a total of 1268 patients. Survival rates were 65% and 71% among adult and pediatric patients, respectively. Patients who didn't suffer from cardiac arrest prior to VA-ECMO had better chances of survival in both populations; adults (OR 0.44; <0.01) and pediatric (OR = 0.32; = 0.006). Younger age was associated with higher survival among the adults (MD= -8.81; <0.01). Additionally, pre-ECMO LVEF was higher among survivors in the pediatric group (MD= 8.23; <0.01). Furthermore, no significant association was detected between sex, VA-ECMO duration, systolic blood pressure, lactate levels, and survival rates among both groups.
Using VA-ECMO in patients with fulminant myocarditis can significantly improve survival outcomes, with improved prognosis observed with younger age among adults and absence of prior history of cardiac arrest in both groups.
暴发性心肌炎（FM）是一种可能危及生命的疾病，需要紧急治疗。作者的研究旨在探讨在成人和儿科患者中使用静脉-动脉体外膜肺氧合（VA-ECMO）支持治疗FM时的临床结局和生存预测因素，以分析这两个群体之间的差异。
检索PubMed、Scopus、Web of Science和Cochrane数据库，查找报告VA-ECMO对诊断为暴发性心肌炎患者影响的研究。使用R 4.2.2版本进行统计分析。
我们的分析纳入了43项研究，共1268例患者。成人和儿科患者的生存率分别为65%和71%。在VA-ECMO之前未发生心脏骤停的患者在这两个群体中的生存机会更好；成人（OR 0.44；<0.01）和儿科（OR = 0.32；= 0.006）。年龄较小与成人较高的生存率相关（MD = -8.81；<0.01）。此外，儿科组幸存者的ECMO前左心室射血分数较高（MD = 8.23；<0.01）。此外，两组之间的性别、VA-ECMO持续时间、收缩压、乳酸水平和生存率之间未检测到显著关联。
在暴发性心肌炎患者中使用VA-ECMO可显著改善生存结局，在成人中年龄较小以及两组均无前心脏骤停病史时观察到预后改善。
