Impella CP assisted recovery of acute COVID 19 fulminant myocarditis presenting as out of hospital cardiac arrest and cardiogenic shock

R. Anantharaman*, AB. Gopalamurugan

Senior Consultant Interventional Cardiologist, Kauvery Hospital, Chennai, Tamilnadu

Background

The mortality rate due to Cardiogenic shock, due to acute fulminant myocarditis is very high, and in a patient with out of hospital cardiac arrest, it is even worse. Impella helps in unloading of the left ventricle in cardiogenic shock patients thereby facilitating recovery of left ventricle. We discuss a case of out of hospital cardiac arrest due to acute COVID 19 myocarditis presenting as cardiogenic shock, whose heart was recovered with Impella CP support.

Case Presentation 

An 18-year-old healthy boy had sudden collapse at home on 30/05/2021, and had initial CPE by family members, and was shocked 5 times before ROSC for VT/VF. His BP was 70 systolic on triple inotropic support, and his serum lactate was 17 with pH of 6.9.  His echo showed severe biventricular dysfunction with LVEF < 15%. His CT Chest showed pulmonary edema and CORADS 5. His rapid antigen test for SARS CoV2 was positive. Impella CP was implanted through LFA access in our Centre, following CAG which showed normal coronaries and RHS showed CPO 0.5 and PAPI 0.8. The plan was to reassess PAPI after 12 h and if still < 0.9 then to add ECMO for RV support (and convert to ECPELLA). Lactate reduced to 2.5 and all inotropes was stopped gradually over 3 h. The CPO was 0.8, 0.9, 1.0 and PAPI 0.9, 0.9, 0.93 at 24, 48 and 72 h post Impella. The Impella CP was explanted on fourth day after his LVEF improved to 50%.

Conclusion

Cardiogenic shock due to OHCA in patients with fulminant myocarditis carry very poor prognosis. Supportive therapy with Impella CP (as a short term MCS) will aid in LV unloading, and facilitate recovery, and help to bridge to recovery or a long-term ventricular assist device/heart transplantation.

Impella-CP

 

Dr-R-Anantharaman

Dr. R. Anantharaman

Senior Consultant Interventional Cardiologist

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