ABSTRACT
Background: Myocarditis and pericarditis can present as mild to life-threatening inflammatory symptoms involving the heart. This has been associated with several drugs and vaccines. We present adverse cardiac events reported after vaccination. Methods: A systematic review of the literature using Medline, Embase, Cochrane, and Scopus was performed to identify cases of adults who developed adverse cardiac events after vaccination from inception through July 2021. Data is reported using descriptive statistics. Results: There were 33 studies describing adverse cardiac events after vaccination with a total of 270 patients. The majority described adverse cardiac events following smallpox vaccine administration, followed by COVID-19 vaccination (12.96%), influenza vaccination (2.59%), tetanus vaccination (0.74%), and pneumococcal vaccination (0.74%). Approximately 85% of cases were male, and 96% of the patients were younger than 65 years old. From the cardiac events, 63.3% described were myocarditis, 13.33% were myopericarditis, 6.66% were acute coronary syndrome, 2.96% were pericarditis and 0.70% developed a pericardial effusion. Troponin levels were elevated in 68.2% of patients. Most developed cardiac events seven days post vaccination and 23.49% developed symptoms within seven days. Management was not described in the majority of the reports. In the cases where treatment was described anti-inflammatory medications were used in 56.09%, colchicine was used in 41.46% and steroids were used in 19.51% of patients. One patient required extra-corporeal membrane oxygenation. All patients recovered except one mortality with smallpox vaccine where biopsy showed eosinophilic epicardial inflammation on autopsy. Conclusion: Adverse cardiac events after vaccination have been reported with different vaccines. Management varies for these patients. These events are rare, and unlikely to be fatal.
ABSTRACT
Background: Acute kidney injury (AKI) is common in critically ill patients receiving extracorporeal membrane oxygenation (ECMO). Use of continuous renal replacement therapy (CRRT) with ECMO may help optimize fluid balance and correct electrolyte abnormalities but may also worsen outcomes. The relationship between AKI, CRRT, and survival in ECMO patients remains poorly defined. The aim of this study was to evaluate AKI outcomes in the setting of ECMO support. We assessed factors that may influence AKI severity, as well as the safety of combined CRRT with ECMO Methods: We performed a retrospective analysis of patients that received ECMO from 2018-2021 at a tertiary hospital, using a prospectively maintained database. All patients requiring CRRT received continuous veno-venous hemodiafiltration (CVVHDF). Data collected includes demographics, ECMO and CRRT parameters, anticoagulation, baseline kidney disease, baseline serum creatinine (sCr), ECMO and CRRT duration, hospital length of stay (LOS), complications (patient and device-related), and outcomes. Results: To date, 16 ECMO patients with AKI have been analyzed. Mean age was 46.6 +/-15.6 years. Eleven (68%) were male, and 50% were African American. ECMO indication included respiratory failure due to COVID-19 (43%), followed by respiratory failure from sepsis (19%). Initial ECMO modality was VV-in 75% and VA-in 25%. Mean baseline sCr and sCr at CRRT initiation were 1.3+/-1 mg/dL and 3.93+/-1.1 mg/dL, respectively. Mean ECMO duration was 30+/-37 days, and mean CRRT duration was 26+/-21 days. Elevated plasma hemoglobin (mean peak 103 mg/dL) levels occurred in 14 (88%) patients. Of 10 (63%) patient surviving to discharge, 3 (30%) were dialysis dependent. sCr at CRRT start did not influence CRRT duration: for sCr<4 mg/dL, mean CRRT duration was 37 days, and for sCr>4 mg/dL, mean CRRT duration was 20 days (p=0.21). Mean creatinine at discharge was 1.78+/-1.1 mg/dL. Conclusions: Our results suggest that CRRT can be safely combined with ECMO to achieve satisfactory patient outcomes. Dialysis independence seems attainable in most patients;however, additional patient enrollment is underway to support this concept with a greater degree of confidence.