tetano
Editor, Senior Moderator
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[SUP]1,[/SUP][SUP]2[/SUP], Akin M[SUP]1,[/SUP][SUP]2[/SUP], Stetskamp S[SUP]1[/SUP], Riehle C[SUP]1[/SUP], Jonigk D[SUP]3[/SUP], Flierl U[SUP]1[/SUP], Pfeffer TJ[SUP]1[/SUP], Hirsch V[SUP]1[/SUP], Dutzmann J[SUP]4[/SUP], Hoeper MM[SUP]5[/SUP], K?hn C[SUP]6[/SUP], Bauersachs J[SUP]1[/SUP], Sch?fer A[SUP]1[/SUP].
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
Mechanical Circulatory Support in Refractory Cardiogenic Shock due to Influenza Virus-Related Myocarditis.
Sieweke JT[SUP]1,[/SUP][SUP]2[/SUP], Akin M[SUP]1,[/SUP][SUP]2[/SUP], Stetskamp S[SUP]1[/SUP], Riehle C[SUP]1[/SUP], Jonigk D[SUP]3[/SUP], Flierl U[SUP]1[/SUP], Pfeffer TJ[SUP]1[/SUP], Hirsch V[SUP]1[/SUP], Dutzmann J[SUP]4[/SUP], Hoeper MM[SUP]5[/SUP], K?hn C[SUP]6[/SUP], Bauersachs J[SUP]1[/SUP], Sch?fer A[SUP]1[/SUP].
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