Analysis of clinical features in children with fulminant myocarditis treated with extracorporeal membrane oxygenation
10.3760/cma.j.issn.1673-4912.2025.08.002
- VernacularTitle:体外膜肺氧合治疗儿童暴发性心肌炎的临床特点分析
- Author:
Na SHI
1
;
Chunfeng LIU
1
Author Information
1. 中国医科大学附属盛京医院儿科，沈阳 110004
- Publication Type:Journal Article
- Keywords:
Children;
Fulminant myocarditis;
Clinical features;
Extracorporeal membrane oxygenation;
Prognosis
- From:
Chinese Pediatric Emergency Medicine
2025;32(8):567-572
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To summarize the clinical features of children with fulminant myocarditis treated with extracorporeal membrane oxygenation(ECMO)，and to explore the influencing factors which may lead to adverse clinical outcomes.Methods:The clinical data of children diagnosed with fulminant myocarditis treated with ECMO in the PICU of Shengjing Hospital Affiliated to China Medical University from October 2016 to November 2023 were retrospectively analyzed.The clinical manifestations, laboratory examination indexes and imaging results were collected. According to the outcome, the cases were divided into survival group and death group, and the related indexes of the two groups were compared.Results:A total of 23 children were included, including 8 males and 15 females, aged from 4 months to 13 years, with a median age of 11 (7,12) years.The initial clinical manifestations were non-specific.In the course of the disease，10 cases（43.5%）developed Adams-Stokes syndrome，7 cases（30.4%）were treated with temporary pacemaker，and 6 cases（26.1%）were treated with extracorporeal cardiopulmonary resuscitation(ECPR).There were 17 cases in the survival group and 6 cases in the death group, and the success rate of ECMO treatment was 73.9%. Six children died within 96 hours of admission, and 5 of them received ECPR.The time from admission to start ECMO and ECMO assistance time in the death group were shorter than those in the survival group, the pediatric logistic organ dysfunction score 2(PELOD-2）and vasoactive inotropic score(VIS) within 24 h after admission were higher than those in the survival group, and the proportion of ECPR was higher than that in the survival group.The procalcitonin, interleukin-6, blood lactic acid, highest values of creatine kinase isoenzyme-MB, troponin T and troponin I in the death group were higher than those in the survival group. The differences were statistically significant ( P<0.05). Conclusion:The clinical manifestations of fulminant myocarditis in children are not typical. The increase of PELOD-2 and VIS scores within 24h after admission, serum creatine kinase isoenzyme-MB, blood lactic acid, troponin and inflammatory indexes may be related to the poor prognosis of children with fulminant myocarditis treated with ECMO. Early initiation of ECMO before cardiac arrest may affect its success rate of treatment.
