Clinical study of extracorporeal membrane oxygenation in patients with fulminant myocarditis

doi:10.3877/cma.j.issn.1674-6880.2016.06.003

Abstract

Abstract:

Objective

To explore the clinical effect of the extracorporeal membrane oxygenation (ECMO) in patients with fulminant myocarditis (FM).

Methods

Observing 8 FM patients admitted to Critical Care Medicine in Hangzhou First People's Hospital from September 2009 to October 2015. All patients accepted vein-artery extracorporeal membrane oxygenation (VA-ECMO) after unsatisfactory results with conventional therapy. The levels of creatine kinase, creatine kinase isoenzyme MB (CK-MB), troponin Ⅰ (TNⅠ), aspartate aminotransferase (AST), actate dehydrogenase(LDH), serum creatinine, blood lactic acid, cardiothoracic ratio and left ventricular ejection fraction (LVEF) before and after VA-ECMO were compared. Meanwhile, all the patients were divided into the surgical group and ultraphonic group accroding to catheter of femoral arterio-venous, 4 patients in each group, and the time of insertion and the occurrence of complications were compared.

Results

Six patients were successfully weaned off and fully recovered cardiac function, while 2 patients eventually died because of heart function irreversible. The levels of creatine kinase [(586 ± 461) U/L vs. (90 ± 38) U/L, t = 2.721, P = 0.042], serum creatinine[(153 ± 70) μmol/L vs. (966 ± 20) μmol/L, t = 3.866, P = 0.012], blood lactic acid [(6.25 ± 3.67) mmol/L vs. (1.23 ± 0.29) mmol/L, t = 3.236, P = 0.023] and LVEF [(0.21 ± 0.16) vs. (0.47 ± 0.05), t = 4.416, P = 0.007] showed significant differences before and after VA-ECMO. The time of insertion in the ultraphonic group was much shorter than that in the surgical group [(24 ± 5) min vs. (72 ± 10) min, t = 7.908, P = 0.004], and no other adverse reactions and complications happened.

Conclusion

ECMO is one of the most effective mechanical circulation support devices, and combined with ultrasound can be better in FM patients.

Key words: Extracorporeal membrane oxygenation, Cardiomyopathies, Fulminant myocarditis

Weihang Hu, Changwen Liu, Wei Hu, Ying Zhu, Jianrong Wang, Bingwei Liu, Yongke Zheng, Jun Lu, Lan Chen. Clinical study of extracorporeal membrane oxygenation in patients with fulminant myocarditis[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2016, 09(06): 371-375.

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References 23

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编号	性别	年龄（岁）	并发症	治疗（μg·kg^-1·min^-1）
1	男	12	心源性休克+ Ⅲ度房室传导阻滞	多巴胺20 μg·kg^-1·min^-1 +多巴酚丁胺40 μg·kg^-1· min^-1
2	女	25	心源性休克+ MODS	多巴胺15 μg·kg^-1·min^-1 +多巴酚丁胺30 μg·kg^-1· min^-1
3	女	21	心源性休克+ Ⅲ度房室传导阻滞	多巴胺20 μg·kg^-1·min^-1 +多巴酚丁胺40 μg·kg^-1·min^-1 +肾上腺素2 μg·kg^-1·min^-1
4	男	18	心脏骤停	ECPR
5	男	21	心脏骤停	ECPR
6	男	58	心源性休克+ Ⅲ度房室传导阻滞	多巴胺20 μg·kg^-1·min^-1 +多巴酚丁胺40 μg·kg^-1·min^-1 +去甲肾上腺素2 μg·kg^-1· min^-1 + IABP
7	男	33	心源性休克+ MODS	多巴胺20 μg·kg^-1·min^-1 +多巴酚丁胺40 μg·kg^-1·min^-1 + IABP
8	女	51	心源性休克+ MODS心源性休克+Ⅲ度房室传导阻滞	多巴胺15 μg·kg^-1·min^-1 +肾上腺素1.6 μg·kg^-1·min^-1 +去甲肾上腺素1.12 μg·kg^-1·min^-1

编号	性别	年龄（岁）	并发症	治疗（μg·kg^-1·min^-1）
1	男	12	心源性休克+ Ⅲ度房室传导阻滞	多巴胺20 μg·kg^-1·min^-1 +多巴酚丁胺40 μg·kg^-1· min^-1
2	女	25	心源性休克+ MODS	多巴胺15 μg·kg^-1·min^-1 +多巴酚丁胺30 μg·kg^-1· min^-1
3	女	21	心源性休克+ Ⅲ度房室传导阻滞	多巴胺20 μg·kg^-1·min^-1 +多巴酚丁胺40 μg·kg^-1·min^-1 +肾上腺素2 μg·kg^-1·min^-1
4	男	18	心脏骤停	ECPR
5	男	21	心脏骤停	ECPR
6	男	58	心源性休克+ Ⅲ度房室传导阻滞	多巴胺20 μg·kg^-1·min^-1 +多巴酚丁胺40 μg·kg^-1·min^-1 +去甲肾上腺素2 μg·kg^-1· min^-1 + IABP
7	男	33	心源性休克+ MODS	多巴胺20 μg·kg^-1·min^-1 +多巴酚丁胺40 μg·kg^-1·min^-1 + IABP
8	女	51	心源性休克+ MODS心源性休克+Ⅲ度房室传导阻滞	多巴胺15 μg·kg^-1·min^-1 +肾上腺素1.6 μg·kg^-1·min^-1 +去甲肾上腺素1.12 μg·kg^-1·min^-1

组别	例数	肌酸激酶(U/L)	CK-MB(U/L)	肌钙蛋白Ⅰ(μg/L)	AST(U/L)	LDH(U/L)
治疗前	6	586 ± 461	74 ± 69	19.6 ± 18.8	744 ± 1 295	1 144 ± 1 745
治疗后	6	90 ± 38	6±3	0.5 ± 0.3	38 ± 19	379 ± 101
t值	?	2.721	2.449	2.519	1.330	1.056
P值	?	0.042	0.058	0.053	0.241	0.339
组别	例数	血肌酐(μmol/L)	乳酸(mmol/L)	心胸比例	LVEF
治疗前	6	153 ± 70	6.25 ± 3.67	0.428 ± 0.031	0.21 ± 0.16
治疗后	6	66 ± 20	1.23 ± 0.29	0.437 ± 0.020	0.47 ± 0.05
t值	?	3.866	3.236	0.496	4.416
P值	?	0.012	0.023	0.641	0.007

组别	例数	肌酸激酶(U/L)	CK-MB(U/L)	肌钙蛋白Ⅰ(μg/L)	AST(U/L)	LDH(U/L)
治疗前	6	586 ± 461	74 ± 69	19.6 ± 18.8	744 ± 1 295	1 144 ± 1 745
治疗后	6	90 ± 38	6±3	0.5 ± 0.3	38 ± 19	379 ± 101
t值	?	2.721	2.449	2.519	1.330	1.056
P值	?	0.042	0.058	0.053	0.241	0.339
组别	例数	血肌酐(μmol/L)	乳酸(mmol/L)	心胸比例	LVEF
治疗前	6	153 ± 70	6.25 ± 3.67	0.428 ± 0.031	0.21 ± 0.16
治疗后	6	66 ± 20	1.23 ± 0.29	0.437 ± 0.020	0.47 ± 0.05
t值	?	3.866	3.236	0.496	4.416
P值	?	0.012	0.023	0.641	0.007

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