Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2026 Aug;38(8):722-728. doi: 10.3760/cma.j.cn121430-20260318-00128.
ABSTRACT
OBJECTIVE: To investigate the clinical efficacy of extracorporeal membrane oxygenation (ECMO) in the treatment of fulminant myocarditis and to identify the risk factors associated with prognosis.
METHODS: A retrospective analysis was conducted on patients diagnosed with fulminant myocarditis and treated with veno-arterial ECMO in the intensive care unit of the First Affiliated Hospital of Zhengzhou University from January 2018 to December 2024. Patients were divided into a survival group and a death group based on whether they achieved successful weaning and hospital discharge. Baseline characteristics, indicators before ECMO, ECMO parameters, and complication rates were compared between the two groups. Univariate and multivariate Logistic regression analyses were performed to determine independent prognostic factors. Kaplan-Meier survival curves were plotted to estimate survival probabilities.
RESULTS: A total of 85 patients were enrolled, including 34 (40%) males and 51 (60%) females; with a median age of 36 (24, 45) years old (14-70 years old); the mean duration of ECMO support was (112.5±48.4) hours. Overall, 58 cases (68%) were successfully weaned and discharged alive. Compared with the survival group, the death group exhibited a significantly longer interval from symptom onset to ECMO initiation (hours: 24.3±10.7 vs. 18.6±8.4), a higher incidence of pre-ECMO cardiac arrest [41% (11/27) vs. 21% (12/58)], elevated pre-ECMO vasoactive-inotropic score (68.3±14.7 vs. 42.5±12.6), lactate (mmol/L: 12.6±2.8 vs. 8.3±1.2), creatinine (μmol/L: 156.8±32.5 vs. 112.6±28.3), N-terminal B-type natriuretic peptide precursor (ng/L: 12 486±67 vs. 8 642±121), and C-reactive protein (mg/L: 124.8±38.4 vs. 86.4±22.6). Conversely, the death group had lower left ventricular ejection fraction (LVEF: 0.223±0.054 vs. 0.285±0.068), cardiac index (mL×s-1×m-2: 25.00±3.33 vs. 30.00±5.00), pH value (7.21±0.15 vs. 7.28±0.12), and oxygenation index [mmHg (1 mmHg=0.133 kPa): 152.3±32.8 vs. 186.4±28.5], all P<0.05. Complications occurred in 55 patients (65%), primarily bleeding (32%), infection (28%), neurological events (15%), and renal dysfunction (22%). The death group had a higher overall complication rate, specifically for neurological complications and renal dysfunction (both P<0.05). Multivariate Logistic regression analysis showed that elevated pre-ECMO lactate [odds ratio (OR)=1.420, 95% confidence interval (95%CI) was 1.179-1.711, P<0.001), ECMO duration>120 hours (OR=3.261, 95%CI was 1.345-7.878, P=0.009), and neurological complications (OR=5.830, 95%CI was 1.919-17.713, P=0.002) were independent risk factors for mortality, while higher LVEF was identified as a protective factor (OR=0.880, 95%CI was 0.786-0.972, P=0.012). Kaplan-Meier survival curve analysis revealed that the 30-day cumulative survival rate of patients with pre-ECMO lactate≥10 mmol/L was lower than that of patients with pre-ECMO lactate<10 mmol/L (Log-rank test: χ 2=5.545, P=0.019). The 30-day cumulative survival rate of patients with LVEF<0.25 was lower than that of patients with LVEF≥0.25 (Log-rank test: χ 2=6.486, P=0.011). The 30-day cumulative survival rate of patients with ECMO duration>120 hours was lower than that of patients with ECMO duration≤120 hours (Log-rank test: χ 2=5.689, P=0.017).
CONCLUSIONS: ECMO-assisted therapy yields a high survival rate in patients with fulminant myocarditis. Elevated pre-ECMO lactate, low LVEF, prolonged ECMO support duration, and the occurrence of neurological complications are independent predictors of in-hospital mortality.
PMID:42693968 | DOI:10.3760/cma.j.cn121430-20260318-00128