Influences of V-A Mode Assisted ECMO Combined with Intra-Aortic Balloon Counterpulsation on Disease Outcome and Troponin Level in Patients with Acute Fulminant Myocarditis

Authors

  • Zhiyong Yuan Department of Critical Care Medicine, The Affiliated Hospital of Qingdao University, 266000 Qingdao, Shandong, China
  • Xiaoning Han Department of Critical Care Medicine, The Affiliated Hospital of Qingdao University, 266000 Qingdao, Shandong, China
  • Fuhua Wang Department of Critical Care Medicine, The Affiliated Hospital of Qingdao University, 266000 Qingdao, Shandong, China
  • Yajun Jing Department of Critical Care Medicine, The Affiliated Hospital of Qingdao University, 266000 Qingdao, Shandong, China
  • Ying Liu Department of Critical Care Medicine, The Affiliated Hospital of Qingdao University, 266000 Qingdao, Shandong, China
  • Weigui Zhou Department of Critical Care Medicine, The Affiliated Hospital of Qingdao University, 266000 Qingdao, Shandong, China
  • Jinyan Xing Department of Critical Care Medicine, The Affiliated Hospital of Qingdao University, 266000 Qingdao, Shandong, China

DOI:

https://doi.org/10.59958/hsf.7573

Keywords:

vein-artery mode, extracorporeal membrane oxygenation, intra-aortic balloon counterpulsation, acute fulminant myocarditis, disease outcome, troponin

Abstract

Introduction: The acute fulminant myocarditis (AFM) is a special type of myocarditis, characterized by rapid onset, progression with abnormal hemodynamics causing high mortality. The combination of extracorporeal membrane oxygenation (ECMO) and intra-aortic balloon counterpulsation (IABP) in these cases have improved the acute phase attacks resulting in increased survival of the effected individuals. To observe the effect of vein-artery (V-A) mode assisted ECMO combined with IABP on the disease outcomes and troponin level in patients with acute fulminant myocarditis (AFM). Methods: A total of 45 patients with AFM were admitted to our hospital from January 2016 to December 2021, they were divided into group A (21 patients, receiving traditional treatment) and group B (24 patients, receiving V-A mode assisted ECMO and IABP based on traditional treatment) according to the treatment plan. The hypersensitive troponin (hs-cTnI), B-type natriuretic peptide (BNP), arterial blood gas analysis index, multiple organ dysfunction score (MODS), simplified acute physiology score II (SAPS II), cardiac ultrasound index, and disease outcomes were compared between the two groups. Results: After treatment, the hs-cTnI, BNP, blood lactic acid, MODS score and SAPS score in both groups were lower than before treatment (p < 0.05), the arterial oxygen saturation (SaO2), left ventricular ejection fraction (LVEF) and cardiac index (CI) was higher than before treatment (p < 0.05), the hs-cTnI, BNP, blood lactic acid, MODS score and SAPS Ⅱ score in group B were lower than  group A (p < 0.05), SaO2, LVEF and CI was higher than group A (p < 0.05). The in-hospital mortality of group B (9.52%, 2/21) was lower than group A (45.83%, 11/24) (χ2 = 7.188, p = 0.007). Among the recovered discharged patients, the length of stay in group B (19 patients, 14.42 ± 4.59 days) was shorter than group A (13 patients, 18.34 ± 5.72 days) (t = 2.147, p = 0.040). Conclusions: V-A mode assisted ECMO combined with IABP can improve the condition and arterial blood gas analysis index and cardiac function of AFM patients, alleviate myocardial injury, reduce mortality in the hospital, and shorten the hospitalization time of the recovered patients.

References

Veronese G, Ammirati E, Cipriani M, Frigerio M. Fulminant myocarditis: Characteristics, treatment, and outcomes. Anatolian Journal of Cardiology. 2018; 19: 279–286.

Hang W, Chen C, Seubert JM, Wang DW. Fulminant myocarditis: a comprehensive review from etiology to treatments and outcomes. Signal Transduction and Targeted Therapy. 2020; 5: 287.

Kociol RD, Cooper LT, Fang JC, Moslehi JJ, Pang PS, Sabe MA, et al. Recognition and Initial Management of Fulminant Myocarditis: A Scientific Statement From the American Heart Association. Circulation. 2020; 141: e69–e92.

Liao X, Li B, Cheng Z. Extracorporeal membrane oxygenation in adult patients with acute fulminant myocarditis: Clinical outcomes and risk factor analysis. Herz. 2018; 43: 728–732.

Ando M, Watanabe N, Saku K, Morishima I. Acute-phase administration of ivabradine supported by intra-aortic balloon pump induces myocardial recovery without significant haemodynamic worsening in a patient with acute fulminant myocarditis: a case report. European Heart Journal. Case Reports. 2022; 6: ytac340.

Jiang J, Wang DW. Treatments of Fulminant Myocarditis in Acute Phase. Fulminant Myocarditis (pp. 227–250). Springer: Singapore. 2022.

Combes A, Price S, Slutsky AS, Brodie D. Temporary circulatory support for cardiogenic shock. Lancet (London, England). 2020; 396: 199–212.

Poncelet AJ, Nieuwburgh MPD, Moniotte S, Beco GD, Carbonez K, Rubay JE, et al. Cardiac surgery with cardiopulmonary bypass in low-weight or preterm neonates: A retrospective study analyzing early outcome. Congenital Heart Disease. 2023; 18: 151–168.

Sun D, Ding H, Zhao C, Li Y, Wang J, Yan J, et al. Value of SOFA, APACHE IV and SAPS II scoring systems in predicting short-term mortality in patients with acute myocarditis. Oncotarget. 2017; 8: 63073–63083.

Nunez JI, Grandin EW, Reyes-Castro T, Sabe M, Quintero P, Motiwala S, et al. Outcomes With Peripheral Venoarterial Extracorporeal Membrane Oxygenation for Suspected Acute Myocarditis: 10-Year Experience From the Extracorporeal Life Support Organization Registry. Circulation. Heart Failure. 2023; 16: e010152.

Nandate H, Nishihara T, Nakata Y, Hamada T, Takasaki Y, Yorozuya T. Enhanced recovery from fulminant myocarditis by treatment with the combined use of the Impella left ventricular assist device with extracorporeal membrane oxygenation: a case series. JA Clinical Reports. 2022; 8: 15.

Ma P, Zhang Z, Song T, Yang Y, Meng G, Zhao J, et al. Combining ECMO with IABP for the treatment of critically Ill adult heart failure patients. Heart, Lung & Circulation. 2014; 23: 363–368.

Quandt D, Callegari A, Niesse O, Christmann M, Meinhold A, Dave H, et al. Early cardiac catheterizations within 30 days post congenital heart surgery in children. Congenital Heart Disease. 2023; 18: 79–95.

Tsangaris A, Alexy T, Kalra R, Kosmopoulos M, Elliott A, Bartos JA, et al. Overview of Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) Support for the Management of Cardiogenic Shock. Frontiers in Cardiovascular Medicine. 2021; 8: 686558.

Punjabi PP, Taylor KM. The science and practice of cardiopulmonary bypass: From cross circulation to ECMO and SIRS. Global Cardiology Science & Practice. 2013; 2013: 249–260.

Klauwer D. ECMO Therapy and the Heart-Lung Machine. A Practical Handbook on Pediatric Cardiac Intensive Care Therapy (pp. 251–272). Springer: Cham. 2019.

Luo Y, Gu Q, Wen X, Li Y, Peng W, Zhu Y, et al. Neurological Complications of Veno-Arterial Extracorporeal Membrane Oxygenation: A Retrospective Case-Control Study. Frontiers in Medicine. 2021; 8: 698242.

Nishi T, Ishii M, Tsujita K, Okamoto H, Koto S, Nakai M, et al. Outcomes of Venoarterial Extracorporeal Membrane Oxygenation Plus Intra-Aortic Balloon Pumping for Treatment of Acute Myocardial Infarction Complicated by Cardiogenic Shock. Journal of the American Heart Association. 2022; 11: e023713.

Published

2024-09-10

How to Cite

Yuan, Z. ., Han, X. ., Wang, F. ., Jing, Y. ., Liu, Y. ., Zhou , W. ., & Xing, J. (2024). Influences of V-A Mode Assisted ECMO Combined with Intra-Aortic Balloon Counterpulsation on Disease Outcome and Troponin Level in Patients with Acute Fulminant Myocarditis. The Heart Surgery Forum, 27(9), E1003-E1009. https://doi.org/10.59958/hsf.7573

Issue

Vol. 27 No. 9 (2024)

Section

Article

Copyright (c) 2024 The Author(s)

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Author Disclosure & Copyright Transfer Agreement