Veno-Arterial Extracorporeal Membrane Oxygenation in the Treatment of Hemodynamically Unstable Lupus Myocarditis: A Retrospective Case Series Study

Figures & data

Table 1 Basic Information of Patients

	Case 1	Case 2	Case 3
Demographic characteristics
Age, years	41	32	22
Gender	Female	Female	Female
BMI, kg/m^2	21.2	20.9	20.7
Underlying diseases	–	–	–
Chief complaint	Fever for 3 weeks	Fever and shortness of breath for 4 days	Chest tightness and shortness of breath for half a month
Characteristics of connective tissue diseases
Arthralgia	Yes	Yes	Yes
Raynaud phenomenon	Yes	Yes	Yes
Rheumatic antibody	Anti Chrom^+, Anti SS-A52kd^+, Anti SS-A60^+, Anti SmRNP^+, Anti RNP-68 ^+, Anti RNPA ^+	Anti Chrom^+, Anti SS-A52kd ^+, Anti SmRNP^+, Anti RNPA ^+	Anti SSA^+, Anti Ds-DNA^+
WBC, 10^9/L	8.06	13.24	28.45
Hemoglobin, g/L	122	120	91
PLT, 10^9/L	159	204	149
CRP, mg/L	32.86	96.17	19.59
PCT, ug/L	0.12	9.05	2.207
ESR, mm/h	5	33	87
CK max, U/L	58	767	167
CK-MB, U/L	3.6	30.4	1
cTNI, ng/mL	0.212	34.27	0.11
BNP, pg/mL	1911	>5000	>5000
MYO, ng/mL	58.1	155.7	>500
ALT, IU/L	124	4092	1535
AST, IU/L	63	8559	3333
Bilirubin, μmol/L	60	13	51
Alb, g/L	23.5	24.5	37.3
LDH, U/L	557	10,597	6560
Cr, umol/L	24	385	277
BUN, mmol/L	4.76	24.17	30.74
eGFR, mL/min	80	50	70
Urine protein	-	++	+
Ferritin, ng/mL	1434	52.9	>15,000
C3, g/L	0.368	0.443	0.36
C4, g/L	0.062	0.112	0.34

Notes: The complement in all 3 patients decreased; Troponin was significantly elevated in 1 patient. -, negative; +, 0.3-0.5g/L; ++, 0.7-1.0g/L.

Abbreviations: BMI, body mass index; WBC, white blood cell; PLT, platelet; CRP, C-reactive protein; PCT, procalcitonin; ESR, erythrocyte sedimentation rate; CK, creatine kinase; cTN, cardiac troponin; BNP, brain natriuretic peptide; MYO, myoglobin; ALT, alanine aminotransferase; AST, aspartate aminotransferase; Alb, albumin; LDH, lactate dehydrogenase; Cr, creatinine; BUN, blood urea nitrogen; EGFR, epithelial growth factor receptor.

Table 2 ECMO-Related Data

	Case 1	Case 2	Case 3
Clinical data before ECMO
PH	7.36	7.46	7.404
Lactate, mmol/L	7.1	11.4	10.1
Blood pressure, mmHg	80/50	70/40	68/40
ECG	Sinus tachycardia, low and flat T-wave	Sinus bradycardia, inverted T wave	Sinus tachycardia, inverted T wave
Chest radiograph	Bilateral lung exudates, pleural effusion. Enlarged heart shadow	Blurred the texture of both lungs, enlarged heart shadow	Blurred the texture of both lungs, decreased transparency, bilateral pleural effusion and enlarged heart shadow
FS, %	16	15	17
LVEF, %	36	32	36
Ventricular septal thickness, mm	14	9	10
Pulmonary artery pressure, mmHg	38	17	44
Pericardial effusion	A small volume	A small to medium volume	A small volume
ECMO-related parameters
Intubation (percutaneous peripheral)	Femoral vein-femoral artery	Femoral vein-femoral artery	Femoral vein-femoral artery
ECMO flow, L	3.2	3.5	3.3
Mechanical ventilation	Sober	Trachea cannula	Sober
Ventilation mode	Noninvasive assisted ventilation	PC-PSV	-
ECMO operation time, days	9	10	5
Clinical data after ECMO
PH	7.45	7.45	7.579
Lactate, mmol/L	2.7	5.2	2.3
Blood pressure, mmHg	106/69	98/60	100/67
ECG	Sinus rhythm, inverted T wave	Sinus rhythm, T wave changes	Sinus rhythm, T wave changes
Chest radiograph	Enlarged heart shadow	The heart shadow is slightly full	A small volume of bilateral pleural effusion. Enlarged heart shadow
FS, %	29	24	29
LVEF, %	52	48	56
Ventricular septal thickness, mm	10	7	10
Pulmonary artery pressure, mmHg	37	22	30
Pericardial effusion	No	A small volume	A small volume

Notes: Two patients have pleural effusion and pericardial effusion; One patient has pericardial effusion.

Abbreviations: ECMO, extracorporeal membrane oxygenation; ECG, electrocardiogram; PSV, pressure support ventilation; FS, left ventricular systolic fraction; LVEF, left ventricular ejection fraction.

Table 3 Primary Disease and Related Treatment

	Case 1	Case 2	Case 3
Glucocorticoid	MP 0.5g	MP 0.5g	MP 1.0g
Immunosuppressants	Rituximab	Tocilizumab	Rituximab
IVIG	20g* 5 days	20g* 5 days	20g* 5 days
IABP	No	No	No
PCI	No	Yes	No
Pacemaker	No	Yes	No
Blood purification	No	CRRT	Artificial liver
Infection	No	Pulmonary infection	Bloodstream infection
ECMO removal	Successful	Successful	Successful
ECMO complications	No	No	No
ICU stay, days	11	14	12
Outcome	Survived	Dead	Dead

Abbreviations: ECMO, extracorporeal membrane oxygenation; IVIG, intravenous immunoglobulin; IABP, intra-aortic balloon pump; PCI, percutaneous coronary intervention; ICU, intensive care unit; CRRT, continuous renal replacement therapy.