Early Prediction Model for Successful Recovery in Patients with Fulminant Myocarditis Supported with Venoarterial Extracorporeal Membrane Oxygenation

Background: Little is known about the best timing and method for prediction of successful recovery in patients with fulminant myocarditis (FM) supported with venoarterial extracorporeal membrane oxygenation (VA-ECMO). Purpose: To develop a prediction model for a successful recovery in patients with FM supported with VA-ECMO. Methods: This was retrospective multicenter chart review. FM patients treated with VA-ECMO (n = 99, female, 42%) were enrolled. We defined recovery success as the successful VA-ECMO decannulation and subsequent discharge (S-group, n = 46). The other patients were defined as recovery failure (F-group, n = 53). Results: The median PCPS run time was 137 hours. At VA-ECMO initiation (0-hr), there was no significant difference in the left ventricular ejection fraction (LVEF) between the two groups. However, the AST concentration was significantly lower in the S-group than F-group. At 48-hr, the LVEF, increase in the LVEF, and reduction of AST from 0-hr were identified as independent predictors in the S-group. Finally, we developed an S-group prediction model comprising those three variables (area under the curve, 0.844; 95% CI, 0.745–0.944). Conclusions: We developed a prediction model for 48 hours after VA-ECMO initiation for a successful recovery in patients with FM. Our early prediction model may contribute to determining whether we should hold out VA-ECMO for a successful recovery or convert to other forms of mechanical circulatory support.