Contemporary Care and Outcomes of Critically-ill Children With Clinically Diagnosed Myocarditis

DAVID M. PENG; DAVID M. KWIATKOWSKI; JAVIER J. LASA; WENDY ZHANG; MOUSUMI BANERJEE; KATHERINE MIKESELL; A. N.N.A. JOONG; JOHN C. DYKES; SEBASTIAN C. TUME; ROBERT A. NIEBLER; SARAH A. TEELE; DARREN KLUGMAN; MICHAEL G. GAIES; KURT R. SCHUMACHER

doi:10.1016/j.cardfail.2023.04.010

Contemporary Care and Outcomes of Critically-ill Children With Clinically Diagnosed Myocarditis

DAVID M. PENG, DAVID M. KWIATKOWSKI, JAVIER J. LASA, WENDY ZHANG, MOUSUMI BANERJEE, KATHERINE MIKESELL, A. N.N.A. JOONG, JOHN C. DYKES, SEBASTIAN C. TUME, ROBERT A. NIEBLER, SARAH A. TEELE, DARREN KLUGMAN, MICHAEL G. GAIES, KURT R. SCHUMACHER

School of Medicine

Research output: Contribution to journal › Article › peer-review

Abstract

Purpose: To describe contemporary management and outcomes in children with myocarditis who are admitted to a cardiac intensive care unit (CICU) and to identify the characteristics associated with mortality. Methods: All patients in the Pediatric Cardiac Critical Care Consortium (PC⁴) registry between August 2014 and June 2021 who were diagnosed with myocarditis were included. Univariable analyses and multivariable logistic regression evaluated the factors associated with in-hospital mortality. Results: There were 847 CICU admissions for myocarditis in 51 centers. The median age was 12 years (IQR 2.7–16). In-hospital mortality occurred in 53 patients (6.3%), and 60 (7.1%) had cardiac arrest during admission. Mechanical ventilation was required in 339 patients (40%), and mechanical circulatory support (MCS) in 177 (21%); extracorporeal membrane oxygenation (ECMO)-only in 142 (16.7%), ECMO-to-ventricular assist device (VAD) in 20 (2.4%), extracorporeal cardiac resuscitation in 43 (5%), and VAD-only in 15 (1.8%) patients. MCS was associated with in-hospital mortality; 20.3% receiving MCS died compared to 2.5% without MCS (P < 0.001). Mortality rates were similar in ECMO-only, ECMO-to-VAD and VAD-only groups. The median time from CICU admission to ECMO was 2.0 hours (IQR 0–9.4) and to VAD, it was 9.9 days (IQR 6.3–16.8). Time to MCS was not associated with mortality. In multivariable modeling of patients’ characteristics, smaller body surface area (BSA) and low eGFR were independently associated with mortality, and after including critical therapies, mechanical ventilation and ECMO were independent predictors of mortality. Conclusion: This contemporary cohort of children admitted to CICUs with myocarditis commonly received high-resource therapies; however, most patients survived to hospital discharge and rarely received VAD. Smaller patient size, acute kidney injury and receipt of mechanical ventilation or ECMO were independently associated with mortality.

Original language	English (US)
Pages (from-to)	350-358
Number of pages	9
Journal	Journal of cardiac failure
Volume	30
Issue number	2
DOIs	https://doi.org/10.1016/j.cardfail.2023.04.010
State	Published - Feb 2024

Keywords

Myocarditis
heart failure
mechanical circulatory support
pediatrics

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine

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10.1016/j.cardfail.2023.04.010

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PENG, DAVID. M., KWIATKOWSKI, DAVID. M., LASA, JAVIER. J., ZHANG, WENDY., BANERJEE, MOUSUMI., MIKESELL, KATHERINE., JOONG, A. N. N. A., DYKES, JOHN. C., TUME, SEBASTIAN. C., NIEBLER, ROBERT. A., TEELE, SARAH. A., KLUGMAN, DARREN., GAIES, MICHAEL. G., & SCHUMACHER, KURT. R. (2024). Contemporary Care and Outcomes of Critically-ill Children With Clinically Diagnosed Myocarditis. Journal of cardiac failure, 30(2), 350-358. https://doi.org/10.1016/j.cardfail.2023.04.010

PENG, DAVIDM, KWIATKOWSKI, DAVIDM, LASA, JAVIERJ, ZHANG, WENDY, BANERJEE, MOUSUMI, MIKESELL, KATHERINE, JOONG, ANNA, DYKES, JOHNC, TUME, SEBASTIANC, NIEBLER, ROBERTA, TEELE, SARAHA, KLUGMAN, DARREN, GAIES, MICHAELG & SCHUMACHER, KURTR 2024, 'Contemporary Care and Outcomes of Critically-ill Children With Clinically Diagnosed Myocarditis', Journal of cardiac failure, vol. 30, no. 2, pp. 350-358. https://doi.org/10.1016/j.cardfail.2023.04.010

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title = "Contemporary Care and Outcomes of Critically-ill Children With Clinically Diagnosed Myocarditis",

abstract = "Purpose: To describe contemporary management and outcomes in children with myocarditis who are admitted to a cardiac intensive care unit (CICU) and to identify the characteristics associated with mortality. Methods: All patients in the Pediatric Cardiac Critical Care Consortium (PC4) registry between August 2014 and June 2021 who were diagnosed with myocarditis were included. Univariable analyses and multivariable logistic regression evaluated the factors associated with in-hospital mortality. Results: There were 847 CICU admissions for myocarditis in 51 centers. The median age was 12 years (IQR 2.7–16). In-hospital mortality occurred in 53 patients (6.3%), and 60 (7.1%) had cardiac arrest during admission. Mechanical ventilation was required in 339 patients (40%), and mechanical circulatory support (MCS) in 177 (21%); extracorporeal membrane oxygenation (ECMO)-only in 142 (16.7%), ECMO-to-ventricular assist device (VAD) in 20 (2.4%), extracorporeal cardiac resuscitation in 43 (5%), and VAD-only in 15 (1.8%) patients. MCS was associated with in-hospital mortality; 20.3% receiving MCS died compared to 2.5% without MCS (P < 0.001). Mortality rates were similar in ECMO-only, ECMO-to-VAD and VAD-only groups. The median time from CICU admission to ECMO was 2.0 hours (IQR 0–9.4) and to VAD, it was 9.9 days (IQR 6.3–16.8). Time to MCS was not associated with mortality. In multivariable modeling of patients{\textquoteright} characteristics, smaller body surface area (BSA) and low eGFR were independently associated with mortality, and after including critical therapies, mechanical ventilation and ECMO were independent predictors of mortality. Conclusion: This contemporary cohort of children admitted to CICUs with myocarditis commonly received high-resource therapies; however, most patients survived to hospital discharge and rarely received VAD. Smaller patient size, acute kidney injury and receipt of mechanical ventilation or ECMO were independently associated with mortality.",

keywords = "Myocarditis, heart failure, mechanical circulatory support, pediatrics",

author = "PENG, {DAVID M.} and KWIATKOWSKI, {DAVID M.} and LASA, {JAVIER J.} and WENDY ZHANG and MOUSUMI BANERJEE and KATHERINE MIKESELL and JOONG, {A. N.N.A.} and DYKES, {JOHN C.} and TUME, {SEBASTIAN C.} and NIEBLER, {ROBERT A.} and TEELE, {SARAH A.} and DARREN KLUGMAN and GAIES, {MICHAEL G.} and SCHUMACHER, {KURT R.}",

note = "Publisher Copyright: {\textcopyright} 2023 Elsevier Inc.",

year = "2024",

month = feb,

doi = "10.1016/j.cardfail.2023.04.010",

language = "English (US)",

volume = "30",

pages = "350--358",

journal = "Journal of cardiac failure",

issn = "1071-9164",

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TY - JOUR

T1 - Contemporary Care and Outcomes of Critically-ill Children With Clinically Diagnosed Myocarditis

AU - PENG, DAVID M.

AU - KWIATKOWSKI, DAVID M.

AU - LASA, JAVIER J.

AU - ZHANG, WENDY

AU - BANERJEE, MOUSUMI

AU - MIKESELL, KATHERINE

AU - JOONG, A. N.N.A.

AU - DYKES, JOHN C.

AU - TUME, SEBASTIAN C.

AU - NIEBLER, ROBERT A.

AU - TEELE, SARAH A.

AU - KLUGMAN, DARREN

AU - GAIES, MICHAEL G.

AU - SCHUMACHER, KURT R.

PY - 2024/2

Y1 - 2024/2

N2 - Purpose: To describe contemporary management and outcomes in children with myocarditis who are admitted to a cardiac intensive care unit (CICU) and to identify the characteristics associated with mortality. Methods: All patients in the Pediatric Cardiac Critical Care Consortium (PC4) registry between August 2014 and June 2021 who were diagnosed with myocarditis were included. Univariable analyses and multivariable logistic regression evaluated the factors associated with in-hospital mortality. Results: There were 847 CICU admissions for myocarditis in 51 centers. The median age was 12 years (IQR 2.7–16). In-hospital mortality occurred in 53 patients (6.3%), and 60 (7.1%) had cardiac arrest during admission. Mechanical ventilation was required in 339 patients (40%), and mechanical circulatory support (MCS) in 177 (21%); extracorporeal membrane oxygenation (ECMO)-only in 142 (16.7%), ECMO-to-ventricular assist device (VAD) in 20 (2.4%), extracorporeal cardiac resuscitation in 43 (5%), and VAD-only in 15 (1.8%) patients. MCS was associated with in-hospital mortality; 20.3% receiving MCS died compared to 2.5% without MCS (P < 0.001). Mortality rates were similar in ECMO-only, ECMO-to-VAD and VAD-only groups. The median time from CICU admission to ECMO was 2.0 hours (IQR 0–9.4) and to VAD, it was 9.9 days (IQR 6.3–16.8). Time to MCS was not associated with mortality. In multivariable modeling of patients’ characteristics, smaller body surface area (BSA) and low eGFR were independently associated with mortality, and after including critical therapies, mechanical ventilation and ECMO were independent predictors of mortality. Conclusion: This contemporary cohort of children admitted to CICUs with myocarditis commonly received high-resource therapies; however, most patients survived to hospital discharge and rarely received VAD. Smaller patient size, acute kidney injury and receipt of mechanical ventilation or ECMO were independently associated with mortality.

AB - Purpose: To describe contemporary management and outcomes in children with myocarditis who are admitted to a cardiac intensive care unit (CICU) and to identify the characteristics associated with mortality. Methods: All patients in the Pediatric Cardiac Critical Care Consortium (PC4) registry between August 2014 and June 2021 who were diagnosed with myocarditis were included. Univariable analyses and multivariable logistic regression evaluated the factors associated with in-hospital mortality. Results: There were 847 CICU admissions for myocarditis in 51 centers. The median age was 12 years (IQR 2.7–16). In-hospital mortality occurred in 53 patients (6.3%), and 60 (7.1%) had cardiac arrest during admission. Mechanical ventilation was required in 339 patients (40%), and mechanical circulatory support (MCS) in 177 (21%); extracorporeal membrane oxygenation (ECMO)-only in 142 (16.7%), ECMO-to-ventricular assist device (VAD) in 20 (2.4%), extracorporeal cardiac resuscitation in 43 (5%), and VAD-only in 15 (1.8%) patients. MCS was associated with in-hospital mortality; 20.3% receiving MCS died compared to 2.5% without MCS (P < 0.001). Mortality rates were similar in ECMO-only, ECMO-to-VAD and VAD-only groups. The median time from CICU admission to ECMO was 2.0 hours (IQR 0–9.4) and to VAD, it was 9.9 days (IQR 6.3–16.8). Time to MCS was not associated with mortality. In multivariable modeling of patients’ characteristics, smaller body surface area (BSA) and low eGFR were independently associated with mortality, and after including critical therapies, mechanical ventilation and ECMO were independent predictors of mortality. Conclusion: This contemporary cohort of children admitted to CICUs with myocarditis commonly received high-resource therapies; however, most patients survived to hospital discharge and rarely received VAD. Smaller patient size, acute kidney injury and receipt of mechanical ventilation or ECMO were independently associated with mortality.

KW - Myocarditis

KW - heart failure

KW - mechanical circulatory support

KW - pediatrics

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Contemporary Care and Outcomes of Critically-ill Children With Clinically Diagnosed Myocarditis

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