Comparison of predictors of survival among fulminant myocarditis patients undergoing veno-arterial extracorporeal membrane oxygenation in the adult and pediatric populations.

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.