WOFAPS 2025 8th World Congress of Pediatric Surgery

Lijun Yang, Ru Lin

Children's Hospital, Zhejiang University School of Medicine

Background and Objectives**: Fulminant myocarditis(FM) in children has an abrupt onset, is difficult to identify, and the disease progresses rapidly with a high mortality. The key to improving the quality of life of children with fulminant myocarditis lies in the timeliness of early diagnosis, the identification of the progression of organ damage and the effectiveness of treatment. This study focuses on two major aspects: the timeliness of early identification and evaluation and the effectiveness of treatment for this disease, and conducts quality control management to explore ways to reduce complications and mortality.

**Methods**: An expert group was organized to formulate a quality control plan for the diagnosis and treatment of fulminant myocarditis in children. Eight tertiary hospitals with the ability of pediatric extracorporeal membrane oxygenation (ECMO) were selected as pilot sites, and training and implementation of the quality control plan for the diagnosis and treatment of fulminant myocarditis in children were carried out. A retrospective analysis was conducted on the data of six years from January 2018 to December 2020 before quality control and from January 2021 to August 2023 after quality control to evaluate the feasibility and efficacy of quality control.

**Results**: A total of 187 children with fulminant myocarditis were enrolled, among which 156 survived and 31 died. The total mortality rate was 16.58% (31/187). The mortality rate decreased from 22.0% before quality control to 12.4% after quality control (P = 0.081). The complications of craniocerebral injury and severe renal injury both decreased from 19.5% to 8.6% (P = 0.029). Among the overall timeliness indicators of evaluation in six years, the completion rates of electrocardiogram, echocardiogram, and blood lactate were relatively high, reaching 86.5% - 98.7%. The completion rates of blood lactate and Glasgow Coma Scale (GCS) significantly increased after the implementation of quality control, from 86.5% and 62.2% to 98.1% and 81.9% respectively (P values were 0.002 and 0.003 respectively). The Vasoactive Inotrope Score (VIS) before ECMO insertion decreased from 23 (10, 60) before quality control to 20 (8, 28) after quality control (P = 0.087), without statistical significance. The highest value of lactate before ECMO insertion was 6.7 (3, 10.3) mmol/L in the three years before quality control and 6.7 (4.1, 11.4) mmol/L in the three years after quality control, with no obvious change. The time from admission to ECMO establishment was shortened from 10.5 ± 17.3 h before quality control to 6.7 ± 10.2 h after quality control (P = 0.037). The utilization rate of Cardiopulmonary resuscitation (CPR) before ECMO decreased from 51.2% before quality control to 28.6% after quality control (P = 0.002). The achievement rates of the effectiveness indicators of anti-shock treatment within 12 hours [blood lactate, Mixed Venous Oxygen Saturation (SvO2), urine output] were significantly correlated with death, with P values of 0.009, 0.000, and 0.000 respectively. Although there was no obvious change in the achievement rates of the three treatment effectiveness indicators before and after quality control, the overall achievement rates of the 12-hour treatment effectiveness indicators in six years had reached 69.1% - 89%.

**Conclusion**: The implementation of the quality control management project for fulminant myocarditis in children has improved the ability of early diagnosis and identification of organ damage. In particular, the significant increase in the completion rates of blood lactate and GCS, which are convenient for clinical operation, has promoted the early establishment of ECMO after admission, reduced the utilization rate of CPR before ECMO, and decreased the mortality rate and the incidence of complications of important organs.