Eur Respir J. Mechanical Circulatory Support in Refractory Cardiogenic Shock due to Influenza Virus-Related Myocarditis

[tetano]

Eur Respir J. 2020 May 12. pii: 2000925. doi: 10.1183/13993003.00925-2020. [Epub ahead of print]
Mechanical Circulatory Support in Refractory Cardiogenic Shock due to Influenza Virus-Related Myocarditis.


Sieweke JT^1,2, Akin M^1,2, Stetskamp S¹, Riehle C¹, Jonigk D³, Flierl U¹, Pfeffer TJ¹, Hirsch V¹, Dutzmann J⁴, Hoeper MM⁵, K?hn C⁶, Bauersachs J¹, Sch?fer A¹.

Author information




Abstract

BACKGROUND:

In patients with influenza-related myocarditis complicated by refractory cardiogenic shock (rCS) there is scarce evidence for mechanical circulatory support (MCS). We sought to investigate the impact of MCS using combined veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and micro-axial flow pumps in rCS complicating influenza-related myocarditis.
METHODS:

This is a prospective and observational analysis from the single center Hannover Cardiac Unloading REgistry (HACURE) from two recent epidemic influenza seasons. We analysed patients with verified influenza virus infection-associated myocarditis complicated by rCS admitted to our ICU on MCS. Subsequently, we performed a propensity score matched analysis to patients with acute myocardial infarction complicated by rCS and non-ischemic cardiomyopathy related rCS.
RESULTS:

We describe a series of seven patients with rCS complicating influenza-related myocarditis (mean age: 56?10 years, 58% males, Influenza A/B n=2/5). No patient had been vaccinated prior to the influenza season. MCS was provided using combined VA-ECMO and Impella. In two patients with out-of-hospital cardiac arrest VA-ECMO had been implanted for extracorporeal-cardiopulmonary resuscitation. All patients died within 18 days after hospital admission. By propensity score-based comparison to patients with myocardial infarction- or non-ischemic cardiomyopathy related rCS with combined MCS, 30-day mortality was significantly higher in influenza-related rCS.
CONCLUSION:

Despite initial stabilisation with combined MCS in patients with rCS complicating influenza-related myocarditis, the detrimental course of shock could not be stopped and all patients died. Potentially, influenza virus infection critically affects other organs besides the heart leading to irreversible end-organ damage, which MCS cannot compensate and, therefore, resulted in a devastating outcome.
Copyright ?ERS 2020.



PMID:32398305DOI:10.1183/13993003.00925-2020