Pediatric Acute Myocarditis With Short-Term Outcomes and Factors for Extracorporeal Membrane Oxygenation: A Single-Center Retrospective Cohort Study in Vietnam

Ta Anh Tuan; Tran Dang Xoay; Phan Huu Phuc; Dau Viet Hung; Nguyen Trong Dung; Nguyen Ly Thinh Truong; Nguyen Van Thuan; Tran Minh Dien

doi:10.3389/fcvm.2021.741260

Pediatric Acute Myocarditis With Short-Term Outcomes and Factors for Extracorporeal Membrane Oxygenation: A Single-Center Retrospective Cohort Study in Vietnam

Front Cardiovasc Med. 2021 Nov 29:8:741260. doi: 10.3389/fcvm.2021.741260. eCollection 2021.

Authors

Ta Anh Tuan^{1

2

3}, Tran Dang Xoay¹, Phan Huu Phuc¹, Dau Viet Hung^{1

2}, Nguyen Trong Dung¹, Nguyen Ly Thinh Truong⁴, Nguyen Van Thuan⁵, Tran Minh Dien^{2

5}

Affiliations

¹ Pediatric Intensive Care Unit, Vietnam National Children's Hospital, Hanoi, Vietnam.
² Children's Department, University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam.
³ Department of Pediatric, Hanoi Medical University, Hanoi, Vietnam.
⁴ Department of Cardiovascular Surgery, Children Heart Center, Vietnam National Children's Hospital, Hanoi, Vietnam.
⁵ Surgical Intensive Care Unit, Vietnam National Children's Hospital, Hanoi, Vietnam.

Abstract

Objective: Data on the management and outcomes of acute myocarditis treated with extracorporeal membrane oxygenation (ECMO) among low- and middle-income countries are limited. This study aimed to determine the short-term outcomes and also identify factors associated with ECMO use among children with acute myocarditis at a tertiary children's hospital in Vietnam. Methods: A single-center, retrospective observational study was conducted between January 2016 and February 2021. Pediatric patients with acute myocarditis, aged 1 month to 16 years, were included. Results: In total, 54 patients (male, 46%; median age, 7 years) with acute myocarditis were included; 37 of them received ECMO support. Thirty percent (16/54) of the patients died, and 12 of them received ECMO. Laboratory variables that differed between survivors and non-survivors included median left ventricular ejection fraction (LVEF) at 48 h (42 vs. 25%; p = 0.001), platelet count (304 g/L [interquartile range (IQR): 243-271] vs. 219 g/L [IQR: 167-297]; p = 0.014), and protein (60 g/dl [IQR: 54-69] vs. 55 [IQR: 50-58]; p = 0.025). Among patients who received ECMO, compared with the survivors, non-survivors had a low LVEF at 48 h (odds ratio (OR), 0.8; 95% confidence interval (CI): 0.6-0.9; p = 0.006) and high vasoactive-inotropic score (OR, 1.0; 95% CI: 1.0-1.0; p = 0.038) and lactate (OR, 2.8; 95% CI, 1.2-6.1; p = 0.013) at 24 h post-ECMO. Conclusions: The case fatality rate among children with acute myocarditis was 30 and 32% among patients requiring ECMO support. Arrhythmia was an indicator for ECMO in patients with cardiogenic shock.

Keywords: acute myocarditis; cardiac arrhythmia; extracorporeal membrane oxygenation; mortality; pediatrics.