Treatment strategy for acute myocarditis in pediatric patients requiring emergency intervention
Abstract Background Patients with acute myocarditis present with a wide range of symptoms. Treatment strategies for pediatric patients with circulatory failure comprise extracorporeal membrane oxygenation (ECMO), emergency temporary pacing, and pharmacotherapy. However, they remain controversial. EC...
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| Format: | Article |
| Language: | English |
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BMC
2023-08-01
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| Series: | BMC Pediatrics |
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| Online Access: | https://doi.org/10.1186/s12887-023-04200-0 |
| _version_ | 1827633142315352064 |
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| author | Yuka Murakoshi Kenji Hoshino |
| author_facet | Yuka Murakoshi Kenji Hoshino |
| author_sort | Yuka Murakoshi |
| collection | DOAJ |
| description | Abstract Background Patients with acute myocarditis present with a wide range of symptoms. Treatment strategies for pediatric patients with circulatory failure comprise extracorporeal membrane oxygenation (ECMO), emergency temporary pacing, and pharmacotherapy. However, they remain controversial. ECMO is an effective treatment but gives rise to several complications; the goal is therefore to avoid excessive treatment as much as possible. We aimed to evaluate the importance of electrocardiogram findings in differentiating severity and establish an appropriate treatment strategy in pediatric patients with acute myocarditis who required emergency interventions. Methods This retrospective study enrolled pediatric patients admitted to and treated in our hospital for acute myocarditis between April 1983 and December 2021. Patients were retrospectively divided into whether circulatory failure occurred (ECMO or temporary pacing was needed; emergency intervention group) or not (pharmacotherapy alone). Results Of the 26 pediatric patients, 11 experienced circulatory failure while 15 did not. In the circulatory failure group, six patients were treated with ECMO (ECMO group) and five patients with temporary pacing (pacing group). In the pacing group, all patients were diagnosed with complete and/or advanced atrioventricular block (CAVB and/or advanced AVB) and narrow QRS. Furthermore, these patients improved only with temporary pacing and pharmacotherapy, without requiring ECMO. Wide QRS complexes (QRS ≥ 0.12 ms) with ST-segment changes were detected on admission in five of six patients in the ECMO group and none in the pacing group (P = 0.015). Although all patients in the ECMO group experienced complications, none did in the pacing group (P < 0.008). Conclusions Regarding emergency intervention for acute myocarditis, ECMO or temporary pacing could be determined based on electrocardiogram findings, particularly wide QRS complexes with ST-segment changes on admission. It is important to promptly introduce ECMO in patients with wide QRS complexes with ST-segment changes, however, patients with CAVB and/or advanced AVB and narrow QRS could improve without undergoing ECMO. Therefore, excessive treatment should be avoided by separating ECMO from temporary pacing based on electrocardiogram findings on admission. |
| first_indexed | 2024-03-09T14:54:25Z |
| format | Article |
| id | doaj.art-9e4e8431061f4b1da3c4b80892231466 |
| institution | Directory Open Access Journal |
| issn | 1471-2431 |
| language | English |
| last_indexed | 2024-03-09T14:54:25Z |
| publishDate | 2023-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pediatrics |
| spelling | doaj.art-9e4e8431061f4b1da3c4b808922314662023-11-26T14:15:43ZengBMCBMC Pediatrics1471-24312023-08-012311810.1186/s12887-023-04200-0Treatment strategy for acute myocarditis in pediatric patients requiring emergency interventionYuka Murakoshi0Kenji Hoshino1Division of Pediatric Cardiology, Saitama Children’s Medical CenterDivision of Pediatric Cardiology, Saitama Children’s Medical CenterAbstract Background Patients with acute myocarditis present with a wide range of symptoms. Treatment strategies for pediatric patients with circulatory failure comprise extracorporeal membrane oxygenation (ECMO), emergency temporary pacing, and pharmacotherapy. However, they remain controversial. ECMO is an effective treatment but gives rise to several complications; the goal is therefore to avoid excessive treatment as much as possible. We aimed to evaluate the importance of electrocardiogram findings in differentiating severity and establish an appropriate treatment strategy in pediatric patients with acute myocarditis who required emergency interventions. Methods This retrospective study enrolled pediatric patients admitted to and treated in our hospital for acute myocarditis between April 1983 and December 2021. Patients were retrospectively divided into whether circulatory failure occurred (ECMO or temporary pacing was needed; emergency intervention group) or not (pharmacotherapy alone). Results Of the 26 pediatric patients, 11 experienced circulatory failure while 15 did not. In the circulatory failure group, six patients were treated with ECMO (ECMO group) and five patients with temporary pacing (pacing group). In the pacing group, all patients were diagnosed with complete and/or advanced atrioventricular block (CAVB and/or advanced AVB) and narrow QRS. Furthermore, these patients improved only with temporary pacing and pharmacotherapy, without requiring ECMO. Wide QRS complexes (QRS ≥ 0.12 ms) with ST-segment changes were detected on admission in five of six patients in the ECMO group and none in the pacing group (P = 0.015). Although all patients in the ECMO group experienced complications, none did in the pacing group (P < 0.008). Conclusions Regarding emergency intervention for acute myocarditis, ECMO or temporary pacing could be determined based on electrocardiogram findings, particularly wide QRS complexes with ST-segment changes on admission. It is important to promptly introduce ECMO in patients with wide QRS complexes with ST-segment changes, however, patients with CAVB and/or advanced AVB and narrow QRS could improve without undergoing ECMO. Therefore, excessive treatment should be avoided by separating ECMO from temporary pacing based on electrocardiogram findings on admission.https://doi.org/10.1186/s12887-023-04200-0Acute myocarditisEmergency interventionExtracorporeal membrane oxygenationTemporary pacingWide QRS complexes |
| spellingShingle | Yuka Murakoshi Kenji Hoshino Treatment strategy for acute myocarditis in pediatric patients requiring emergency intervention BMC Pediatrics Acute myocarditis Emergency intervention Extracorporeal membrane oxygenation Temporary pacing Wide QRS complexes |
| title | Treatment strategy for acute myocarditis in pediatric patients requiring emergency intervention |
| title_full | Treatment strategy for acute myocarditis in pediatric patients requiring emergency intervention |
| title_fullStr | Treatment strategy for acute myocarditis in pediatric patients requiring emergency intervention |
| title_full_unstemmed | Treatment strategy for acute myocarditis in pediatric patients requiring emergency intervention |
| title_short | Treatment strategy for acute myocarditis in pediatric patients requiring emergency intervention |
| title_sort | treatment strategy for acute myocarditis in pediatric patients requiring emergency intervention |
| topic | Acute myocarditis Emergency intervention Extracorporeal membrane oxygenation Temporary pacing Wide QRS complexes |
| url | https://doi.org/10.1186/s12887-023-04200-0 |
| work_keys_str_mv | AT yukamurakoshi treatmentstrategyforacutemyocarditisinpediatricpatientsrequiringemergencyintervention AT kenjihoshino treatmentstrategyforacutemyocarditisinpediatricpatientsrequiringemergencyintervention |