Rescue for acute myocarditis with shock by extracorporeal membrane oxygenation.
BACKGROUND
Acute myocarditis (AM) complicated with refractory cardiogenic shock carries a very high mortality. We report our experience in treating these patients, who were rescued by extracorporeal membrane oxygenation (ECMO) and intravenous immunoglobulin.


METHODS
Over a 5-year period, 5 patients with AM were rescued with ECMO in our hospital. Femoral venoarterial ECMO was performed in 4 patients, and right atrium-left atrium-aorta ECMO in the other 1 due to ventricular dysfunction. Hemofiltration was applied to 3 patients. Marked elevated creatine kinase, its MB form, and troponin T (TnT) were found before ECMO.


RESULTS
All the patients could be weaned off the ECMO after 140.0+/-57.7 hours of ECMO support. One patient died of multiple organ failure 10 days later after removal of ECMO, resulting in a 20% mortality. Renal function returned to normal in all survivors. The 4 survivors were discharged uneventfully in 23.3+/-8.3 days and resumed functional class I status. The TnT level declined to the low level within 3 days (slope -4.94+/-1.18 ng/mL/day), and might be an indicator of good recovery of myocardium.


CONCLUSIONS
ECMO can provide an effective and simple treatment for critical AM with a satisfactory result and reduce the possibility of progressive cardiomyopathy.
Chen
Y S
YS
Department of Surgery, National Taiwan University Hospital, Taipei.
Wang
M J
MJ
Chou
N K
NK
Han
Y Y
YY
Chiu
I S
IS
Lin
F Y
FY
Chu
S H
SH
Ko
W J
WJ
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D002648:Child; D003402:Creatine Kinase / Q000097:blood; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007527:Isoenzymes; D008297:Male; D009205:Myocarditis / Q000097:blood / Q000150:complications / Q000401:mortality / Q000628:therapy*; D012770:Shock, Cardiogenic / Q000209:etiology*; D015996:Survival Rate; D020107:Troponin T / Q000097:blood
D016756:Immunoglobulins, Intravenous; D007527:Isoenzymes; D020107:Troponin T; D003402:Creatine Kinase