PT - JOURNAL ARTICLE AU - Jan-Thorben Sieweke AU - Muharrem Akin AU - Sebastian Stetskamp AU - Christian Riehle AU - Danny Jonigk AU - Ulrike Flierl AU - Tobias Jonathan Pfeffer AU - Valentin Hirsch AU - Jochen Dutzmann AU - Marius M. Hoeper AU - Christian Kühn AU - Johann Bauersachs AU - Andreas Schäfer TI - Mechanical Circulatory Support in Refractory Cardiogenic Shock due to Influenza Virus-Related Myocarditis AID - 10.1183/13993003.00925-2020 DP - 2020 Jan 01 TA - European Respiratory Journal PG - 2000925 4099 - http://erj.ersjournals.com/content/early/2020/05/07/13993003.00925-2020.short 4100 - http://erj.ersjournals.com/content/early/2020/05/07/13993003.00925-2020.full AB - Background In patients with influenza-related myocarditis complicated by refractory cardiogenic shock (rCS) there is scarce evidence for mechanical circulatory support (MCS). We sought to investigate the impact of MCS using combined veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and micro-axial flow pumps in rCS complicating influenza-related myocarditis.Methods This is a prospective and observational analysis from the single center Hannover Cardiac Unloading REgistry (HACURE) from two recent epidemic influenza seasons. We analysed patients with verified influenza virus infection-associated myocarditis complicated by rCS admitted to our ICU on MCS. Subsequently, we performed a propensity score matched analysis to patients with acute myocardial infarction complicated by rCS and non-ischemic cardiomyopathy related rCS.Results We describe a series of seven patients with rCS complicating influenza-related myocarditis (mean age: 56±10 years, 58% males, Influenza A/B n=2/5). No patient had been vaccinated prior to the influenza season. MCS was provided using combined VA-ECMO and Impella. In two patients with out-of-hospital cardiac arrest VA-ECMO had been implanted for extracorporeal-cardiopulmonary resuscitation. All patients died within 18 days after hospital admission. By propensity score-based comparison to patients with myocardial infarction- or non-ischemic cardiomyopathy related rCS with combined MCS, 30-day mortality was significantly higher in influenza-related rCS.Conclusion Despite initial stabilisation with combined MCS in patients with rCS complicating influenza-related myocarditis, the detrimental course of shock could not be stopped and all patients died. Potentially, influenza virus infection critically affects other organs besides the heart leading to irreversible end-organ damage, which MCS cannot compensate and, therefore, resulted in a devastating outcome.FootnotesThis manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.Conflict of interest: Dr. Sieweke reports other from ABIOMED, outside the submitted work.Conflict of interest: Dr. Akin has nothing to disclose.Conflict of interest: Mr. Stetskamp has nothing to disclose.Conflict of interest: Dr. Riehle reports other from Abiomed, outside the submitted work.Conflict of interest: Dr. Jonigk has nothing to disclose.Conflict of interest: Dr. Flierl has nothing to disclose.Conflict of interest: Dr. Pfeffer has nothing to disclose.Conflict of interest: Dr. Hirsch has nothing to disclose.Conflict of interest: Dr. Dutzmann has nothing to disclose.Conflict of interest: Dr. Höper reports personal fees from Actelion, Bayer, MSD, and Pfizer, outside the submitted work.Conflict of interest: Dr. Kühn has nothing to disclose.Conflict of interest: Dr. Bauersachs reports personal fees from Novartis, personal fees from BMS, personal fees from Pfizer, grants and personal fees from Vifor, personal fees from Bayer, personal fees from Servier, grants and personal fees from CvRX, personal fees from MSD, personal fees from Boehringer Ingelheim, personal fees from Astra Zeneca, grants and personal fees from Abiomed, personal fees from Abbott, personal fees from Medtronic, personal fees from Daiichi Sankyo, grants and personal fees from Zoll, outside the submitted work.Conflict of interest: Dr. Schäfer reports grants and personal fees from Abiomed, during the conduct of the study.