Risk Factors for Cardiac Arrest or Mechanical Circulatory Support in Children with Fulminant Myocarditis

Joseph R. Casadonte, Mjaye L. Mazwi, Katheryn E. Gambetta, Hannah L. Palac, Mary E. McBride, Osama M. Eltayeb, Michael C. Monge, Carl L. Backer, John M. Costello*

*Corresponding author for this work

Research output: Contribution to journalArticle

10 Scopus citations

Abstract

In children with fulminant myocarditis (FM), we sought to describe presenting characteristics and clinical outcomes, and identify risk factors for cardiac arrest and mechanical circulatory support (MCS). A retrospective review of patients with FM admitted at our institution between January 1, 2004, and June 31, 2015, was performed. We compared characteristics and outcomes of FM patients who received cardiopulmonary resuscitation (CPR) and/or were placed on MCS (CPR/MCS group) to those who did not develop these outcomes (Control group). There were 28 patients who met criteria for FM. Median age was 1.2 years (1 day–17 years). Recovery of myocardial function occurred in 13 patients (46%); 6 (21%) had chronic ventricular dysfunction, 6 (21%) underwent heart transplantation, and 3 (11%) died prior to hospital discharge (including one death following heart transplant). Of the 28 FM patients, 13 (46%) developed cardiac arrest (n = 11) and/or received MCS (n = 8). When compared to controls, patients in the CPR/MCS group had a higher peak b-type natriuretic peptide (BNP) levels (p = 0.03) and peak inotropic scores (p = 0.02). No significant differences were found between groups in demographics; chest radiograph, electrocardiogram, or echocardiogram findings; or initial laboratory values including BNP, troponin, C-reactive protein, lactate, and creatinine (p > 0.05 for all). Children with FM are at high risk of cardiovascular collapse leading to the use of CPR or MCS. Aside from peak BNP levels and inotropic scores, the most presenting characteristics were not helpful for predicting these outcomes. FM patients should ideally receive care in centers that provide emergent MCS.

Original languageEnglish (US)
Pages (from-to)128-134
Number of pages7
JournalPediatric cardiology
Volume38
Issue number1
DOIs
StatePublished - Jan 1 2017

Keywords

  • Children
  • Extracorporeal membrane oxygenation
  • Fulminant myocarditis
  • Inotropic score
  • Viral myocarditis

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Cardiology and Cardiovascular Medicine

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