Retrospective analysis of ECMO for acute fulminant viral myocarditis-our institutional experience Rajamani Selvakumar, Prakash P.V.S., Immanuel Sam, Lavanya R, Cousigan V, Dr Shetty Varun Narayana Hrudayalaya, Bangalore Online published on 17 October, 2018. Abstract Background The inflammation or degeneration of the heart muscle called myocarditis may be fatal. This disease often goes undetected. It may also disguise itself as ischemic, valvular, or hypertensive heart disease. Here we report 8 cases of acute fulminant viral myocarditis suffering from low cardiac output, ARDS (Acute respiratory distress syndrome) formation and successfully treated by ECMO. Management All the cases were admitted in the emergency coronary care unit with severe respiratory distress and poor hemodynamics and ECHO examination revealed low LVEF (15–20%). Patients were electively ventilated and consent taken for instituting peripheral VA ECMO. VA ECMO was initiated with femorofemoral cannulation with distal limb perfusion. On ECMO support the hemodynamics were stabilized, with no Inotropic support. The heart and lungs were given adequate rest time for recovery by maintaining total cardiac output on ECMO. The average ECMO support was 84.2 Hours ± 4hours. Maquet Quadrox PLS/Sorin Dideco ECMO oxygenators with rotaflow centrifugal pump were used. Delta pressure, pre pump pressures were continuously monitored. NIRS monitoring and online venous saturation were used to optimize perfusion adequacy. Results Out of the eight cases put on VA ECMO for viral myocarditis seven were successfully weaned off and were discharged (Success rate of 87.5%). Soon after the initiation of ECMO the SaO2 reaches to normal levels. The serum lactate levels which were high (>6mmol/L) prior to initiation of ECMO remarkably came down to <2mmol/L after 24 hours. Seven patients were weaned off and decannulated in the Operating Room. One patient required LV decompression by Balloon Atrial Septostomy in the Hybrid OR and was successfully weaned off after 48 hours. One patient succumbed due to continuous low cardiac output which was irreversible with full blown septicemia and was not responding to ECMO and medications. Conclusion Peripheral VA-ECMO support is very effective in optimizing myocardial recovery for the treatment of refractory acute fulminant viral myocarditis when maximal conventional supports are ineffective. Top Keywords Extracorporeal membrane oxygenation, Fulminant myocarditis, Troponin, ARDS. Top |