Key result
VAD or combination MCS shows no mortality difference versus non-ECPR ECMO in pediatric myocarditis.
Why the study?
The study was designed to describe MCS strategies used in a nationwide cohort of pediatric patients with myocarditis, identify trends over time, and compare outcomes between MCS strategies.
Does the type of mechanical circulatory support (VAD or combination MCS vs non-ECPR ECMO) affect mortality in pediatric patients with myocarditis?
Cohort (n=5,661)
Yes
Does the type of mechanical circulatory support (VAD or combination MCS vs non-ECPR ECMO) affect mortality in pediatric patients with myocarditis?
p-value: p=0.07
In pediatric myocarditis requiring mechanical circulatory support, ECMO is the most common modality, and mortality remains high (28.3%) regardless of the specific MCS strategy used.
High mortality persists across MCS strategies in pediatric myocarditis; observational data leaves optimal choice open for future trials.
Background: Myocarditis is a common cause of pediatric heart failure which may require mechanical circulatory support (MCS). The purpose of this study is to describe MCS strategies used in a nationwide cohort of pediatric patients with myocarditis, identify trends over time, and compare outcomes between MCS strategies. Methods: This study utilized the Kids' Inpatient Database (KID), a national sample of administrative discharge data. KID admissions from 2003-2016 were queried using ICD-9/10 codes to identify those with a diagnosis of myocarditis. MCS outcomes were compared using logistic regression. Results: Of 5,661 admissions for myocarditis, MCS was used in 424 (7.5%), comprised of extracorporeal membrane oxygenation (ECMO) in 312 (73.6%), including 32 (10.2%) instances of extracorporeal cardiopulmonary resuscitation (ECPR), temporary ventricular assist devices (tVAD) in 28 (6.6%), durable VAD (dVAD) in 42 (9.9%) and combination MCS in 42 (9.9%). MCS use increased over time (p=0.031), but MCS strategies did not significantly change. Mortality was high in the MCS group (28.3%). There was no difference in odds of death in the VAD only or combination MCS group compared to the non-ECPR ECMO group (p=0.07 and p=0.65, respectively). Conclusion: MCS is used in 1 in 13 pediatric myocarditis cases, and MCS use is increasing over time with ECMO remaining the most frequently used modality. Mortality remains high in patients that receive MCS but does not differ between those receiving VAD or combination MCS as compared to non-ECPR ECMO on unadjusted analysis. Further prospective analysis is required to evaluate the relative effectiveness of MCS modalities in this disease.
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Kamsheh et al. (2023) conducted a cohort in Pediatric myocarditis (n=5,661). Mechanical circulatory support (MCS) including ECMO, tVAD, dVAD, and combination MCS vs. Non-ECPR ECMO was evaluated on Mortality (p=0.07). Mechanical circulatory support was used in 7.5% of pediatric myocarditis admissions with 28.3% mortality, showing no difference in odds of death between VAD or combination MCS versus non-ECPR ECMO.
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