• Akinori Sawamura, Takahiro Okumura, Akihiro Hirakawa, Masaaki Ito, Yukio Ozaki, Nobuyuki Ohte, Tetsuya Amano, Toyoaki Murohara, and CHANGE PUMP Investigators.
• Department of Cardiology, Nagoya University Graduate School of Medicine.
• Circ. J. 2018 Feb 23; 82 (3): 699-707.

BackgroundCardiac recovery and prevention of end-organ damage are the cornerstones of establishing successful bridge to recovery (BTR) in patients with fulminant myocarditis (FM) supported with percutaneous venoarterial extracorporeal membrane oxygenation (VA-ECMO). However, the timing and method of successful BTR prediction still remain unclear. We aimed to develop a prediction model for successful BTR in patients with FM supported with percutaneous VA-ECMO.Methods and Results:This was a retrospective multicenter chart review enrolling 99 patients (52±16 years; female, 42%) with FM treated with percutaneous VA-ECMO. The S-group comprised patients who experienced percutaneous VA-ECMO decannulation and subsequent discharge (n=46), and the F-group comprised patients who either died in hospital or required conversion to other forms of mechanical circulatory support (n=53). At VA-ECMO initiation (0-h), the S-group had significantly higher left ventricular ejection fraction (LVEF) and lower aspartate aminotransferase (AST) concentration than the F-group. At 48 h, the LVEF, increase in the LVEF, and reduction of AST from 0-h were identified as independent predictors in the S-group. Finally, we developed an S-group prediction model comprising these 3 variables (area under the curve, 0.844; 95% confidence interval, 0.745-0.944).ConclusionsWe developed a model for use 48 h after VA-ECMO initiation to predict successful BTR in patients with FM.

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