The Use of Extracorporeal Membrane Oxygenation in a Patient with Septic Myocarditis in the Postpartum Period

Introduction. Septic myocarditis is a rare disease (from 10 to 22 cases per 100 000 people). The cause of death is usually acute heart failure, hemodynamically significant cardiac arrhythmias, or thromboembolism. Patients in critical condition suffering from infectious myocarditis require massive cardiotonic support to maintain the necessary cardiac output with reduced myocardial contractile function, which leads to an increase in the need for cardiomyocytes for oxygen and aggravates their damage. Veno-arterial extracorporeal membrane oxygenation (ECMO) allows partial or complete replacement of cardiac function and reduces the dose of inotropic drugs, improve oxygen delivery and thereby contribute to the rapid restoration of cardiac function.

The purpose of this publication is to demonstrate in a clinical case the successful experience of ECMO in the treatment of a patient with septic myocarditis in the early postpartum period.

Materials and methods. A 28-year-old patient, data from medical records at the previous stages of treatment and at the Sverdlovsk Regional Clinical Hospital No. 1.

Results. On the third day of treatment, the patient’s condition worsened due to the progression of cardiovascular and respiratory failure. A veno-arterial ECMO procedure was initiated, which lasted 6 days.

Discussion. Positive dynamics in the patient’s condition were observed during six days of ECMO (normalization of echocardiography parameters, levels of cardiac enzymes and natriuretic peptide).

Conclusion. Veno-arterial ECMO as a temporary method of mechanical support of the left ventricle and prosthetic pulmonary function can be successfully used until their recovery in patients with septic myocarditis in the postpartum period.

1. Broman LM, Taccone FS, Lorusso R, Malfertheiner MV, Pappalardo F, Di Nardo M, et al. The ELSO Maastricht Treaty for ECLS Nomenclature: Abbreviations for cannulation configuration in extracorporeal life support — a position paper of the Extracorporeal Life Support Organization. Critical Care. 2019;23(1):36. DOI: https://doi.org/10.1186/s13054-019-2334-8.

2. Hill JD, O’Brien TG, Murray JJ, Dontigny L, Bramson ML, Osborn JJ, et al. Prolonged extracorporeal oxygenation for acute post-traumatic respiratory failure (shock-lung syndrome). Use of the Bramson membrane lung. The New England Journal of Medicine. 1972;286(12):629–634. DOI: https://doi.org/10.1056/NEJM197203232861204.

3. Murphy DA, Hockings LE, Andrews RK, Aubron C, Gardiner EE, Pellegrino VA, et al. Extracorporeal membrane oxygenation — hemostatic complications. Transfusion Medicine Reviews. 2015;29(2):90–101. DOI: https://doi.org/10.1016/j.tmrv.2014.12.001.

4. Bartlett RH. Extracorporeal life support: History and new directions. ASAIO Journal 2005;51(5):487–489. DOI: https://doi.org/10.1097/01.mat.0000179141.08834.cb.

5. Pham T, Combes A, Roze H, Chevret S, Merkat A, Roch A, et al. Extracorporeal membrane oxygenation for pandemic influenza A (H1N1)-induced acute respiratory distress syndrome: A cohort study and propensity-matched analysis. American Journal of Respiratory and Critical Care Medicine. 2013;187(3):276–285. DOI: https://doi.org/10.1164/rccm.201205-0815OC.

6. Barbaro RP, MacLaren G, Boonstra PS, Iwashyna TD, Slutsky AS, Fan E, et al. Extracorporeal membrane oxygenation support in COVID-19: An international cohort study of the Extracorporeal Life Support Organization registry. The Lancet. 2020;396(10257):1071–1078. DOI: https://doi.org/10.1016/S0140-6736(20)32008-0.

7. Olejniczak M, Schwartz M, Webber E, Shaffer A, Perry T. Viral myocarditis — incidence, diagnosis and management. Journal of Cardiothoracic and Vascular Anesthesia. 2020;34(6):1591–1601. DOI: https://doi.org/10.1053/j.jvca.2019.12.052.

8. Ciccone MM, Dentamaro I, Carbonara S, Ricci G, Vestito D, Marzullo A, et al. Fulminant peripartum myocarditis associated with sudden cardiac death: A case report. Cardiovascular Pathology. 2016;25(2):87–89. DOI: https://doi.org/10.1016/j.carpath.2015.10.005.

9. Olson TL, O’Neil ER, Ramanathan K, Lorusso R, MacLaren G, Anders MM. Extracorporeal membrane oxygenation in peripartum cardiomyopathy: A review of the ELSO Registry. International Journal of Cardiology. 2020;311:71–76. DOI: https://doi.org/10.1016/j.ijcard.2020.03.006.

10. Ferreira FL, Bota DP, Bross A, Mélot C, Vincent JL. Serial evaluation of the SOFA score to predict outcome in critically ill patients. JAMA. 2001;286(14):1754–1758. DOI: https://doi.org/10.1001/jama.286.14.1754.

11. Sessler CN, Gosnell MS, Grap MJ, Brophy GM, O’Neal PV, Keane KA, et al. The Richmond Agitation-Sedation Scale: Validity and reliability in adult intensive care unit patients. American Journal of Respiratory and Critical Care Medicine. 2002;166(10):1338–1344. DOI: https://doi.org/10.1164/rccm.2107138.

12. Falk L, Sallisalmi M, Lindholm JA. Differential hypoxemia during venoarterial extracorporeal membrane oxygenation. Perfusion. 2019;34(1 Suppl):22–29. DOI: https://doi.org/10.1177/0267659119830513.

13. Mitrofanova LB. The role of myocardial biopsy in diagnostics of inflammatory myocardium diseases. Russian Journal of Cardiology. 2016;(1):73–79. (In Russ.). DOI: https://doi.org/10.15829/1560-4071-2016-1-73-79.

14. Lampejo T, Durkin SM, Bhatt N, Guttmann O. Acute myocarditis: Aetiology, diagnosis and management. Clinical Medicine. 2021;21(5):e505–e510. DOI: https://doi.org/10.7861/clinmed.2021-0121.

15. Arutyunov GP, Paleev FN, Moiseeva OM, Dragunov DO, Sokolova AV, Arutyunov AG, et al. 2020 Clinical practice guidelines for Myocarditis in adults. Russian Journal of Cardiology. 2021;26(11):4790. (In Russ.). DOI: https://doi.org/10.15829/1560-4071-2021-4790.

16. Hang W, Chen C, Seubert JM, Wang DW. Fulminant myocarditis: A comprehensive review from etiology to treatments and outcomes. Signal Transduction and Targeted Therapy. 2020;5(1):287. DOI: https://doi.org/10.1038/s41392-020-00360-y.

17. McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. European Heart Journal. 2021;42(36):3599–3726. DOI: https://doi.org/10.1093/eurheartj/ehab368.