Survival of neonates with enteroviral myocarditis requiring extracorporeal membrane oxygenation

Objectives: Neonates infected with enteroviruses may present with severe myocarditis and medically refractory cardiopulmonary collapse. Extracorporeal membrane oxygenation (ECMO) has been used to support patients in this setting, but its efficacy has not been systematically studied. We sought to review the Extra-corporeal Life Support Organization registry to determine survival rates and identify predictors of inhospital mortality for these neonates. Design: Retrospective cohort study using data reported to the Extracorporeal Life Support Organization registry. Setting: Multi-institutional data. Patients: Patients <= 15 days old with enteroviral myocarditis who required ECMO support between 2000 and 2008. Interventions: None. Measurements and Main Results: Twenty-four neonates with enteroviral myocarditis were reported to the Extracorporeal Life Support Organization registry during the study period. The survival to hospital discharge rate was 33% (n = 8). Multisystem organ dysfunction was more common in nonsurvivors than in survivors (75% vs. 0%, p <.01). In particular, nonsurvivors had a higher prevalence of renal dysfunction (50% vs. 0%, p = .02). Nonsurvivors also had a greater number of ECMO-related complications (5 vs. 3.5, p = .03). Conclusions: Cardiopulmonary support with ECMO should be considered for neonates with severe enteroviral myocarditis that fails conventional medical therapies. Multisystem organ dysfunction, particularly with renal involvement, may portend a poor prognosis and is one of several factors that should be considered in the decision to initiate and/or continue mechanical support for these patients. (Pediatr Crit Care Med 2011; 12:314-318)