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Survival of neonates with enteroviral myocarditis requiring extracorporeal membrane oxygenation

Madden, Kate MD; Thiagarajan, Ravi R. MD, MPH; Rycus, Peter T. MPH; Rajagopal, Satish K. MD

Pediatric Critical Care Medicine: May 2011 - Volume 12 - Issue 3 - pp 314-318
doi: 10.1097/PCC.0b013e3181e8b44b
Neonatal Intensive Care

Objectives: Neonates infected with enteroviruses may present with severe myocarditis and medically refractory cardiopulmonary collapse. Extracorporeal membrane oxygenation (ECMO) has been used to support patients in this setting, but its efficacy has not been systematically studied. We sought to review the Extracorporeal Life Support Organization registry to determine survival rates and identify predictors of inhospital mortality for these neonates.

Design: Retrospective cohort study using data reported to the Extracorporeal Life Support Organization registry.

Setting: Multi-institutional data.

Patients: Patients ≤15 days old with enteroviral myocarditis who required ECMO support between 2000 and 2008.

Interventions: None.

Measurements and Main Results: Twenty-four neonates with enteroviral myocarditis were reported to the Extracorporeal Life Support Organization registry during the study period. The survival to hospital discharge rate was 33% (n = 8). Multisystem organ dysfunction was more common in nonsurvivors than in survivors (75% vs. 0%, p < .01). In particular, nonsurvivors had a higher prevalence of renal dysfunction (50% vs. 0%, p = .02). Nonsurvivors also had a greater number of ECMO-related complications (5 vs. 3.5, p = .03).

Conclusions: Cardiopulmonary support with ECMO should be considered for neonates with severe enteroviral myocarditis that fails conventional medical therapies. Multisystem organ dysfunction, particularly with renal involvement, may portend a poor prognosis and is one of several factors that should be considered in the decision to initiate and/or continue mechanical support for these patients.

From the Departments of Anesthesia (KM) and Cardiology (RRT, SKR), Children's Hospital Boston, Boston, MA; the Extracorporeal Life Support Organization (PTR), Ann Arbor, MI; and the Department of Pediatrics (RRT, SKR), Harvard Medical School, Boston, MA.

All work was performed at the Children's Hospital Boston, Boston, MA.

This study was supported, in part, by the Cardiac Intensive Care Unit Research Fund of the Children's Hospital Boston.

Dr. Thiagarajan has consulted one time for Children's National Medical Center in Washington, DC. He received honoraria/speaking fees one time from Children's Hospital Seattle. The remaining authors have not disclosed any potential conflicts of interest.

For information regarding this article, E-mail: satish.rajagopal@cardio.chboston.org

©2011The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies