title: Experience and result of extracorporeal membrane oxygenation in treating fulminant myocarditis with shock: what mechanical support should be considered first?
abstract: BACKGROUND
  Extracorporeal membrane oxygenation (ECMO), instead of ventricular assist device (VAD), could work as the first-line treatment of choice for fulminant myocarditis (FM) with profound shock if intraaortic balloon pumping was inadequate. We reviewed our experience in treating FM with ECMO and compared it with the literature that described the use of VAD.
  
  
  METHODS
  Fifteen consecutive patients (age 27.1 +/- 19.3 years) who had FM with profound shock were rescued with ECMO emergently. Hypotension, depressed left ventricular ejection fraction (19.1% +/- 6.1%), and oliguria occurred in all patients with high-dose catecholamine (inotropic equivalents: 69.0 +/- 37.7 microg/kg/min) and ventilator support. Before ECMO support, 6 patients received intraaortic balloon pumping support, 5 received external cardiac massage, 5 needed a temporary pacemaker, and 4 needed continuous hemofiltration. The pre-ECMO cardiac enzyme and liver enzyme levels were abnormally high.
  
  
  RESULTS
  Fourteen patients (93.3%) could be weaned off mechanical support. Three of 14 successfully weaned patients died later as a result of complications. Survival to discharge was 73.3%, and none of survivors needed heart transplantation. The ECMO duration was 137.7 +/- 74.5 hours. The ECMO-related neurological complication (6.7%) and the reexploration rate for hemostasis (8.9%) were lower than the myocarditis group supported by VAD from the literature review. The 11 survivors exhibited no cardiac dysfunction during the follow-up period.
  
  
  CONCLUSIONS
  Owning to advantages of fewer complications, easier application, and biventricular support, ECMO can be considered as the first-line treatment of mechanical support for FM with profound shock when intraaortic balloon pumping is inadequate or infeasible.
authors.affiliation: Department of Cardiovascular Surgery, National Taiwan University Hospital, 7 Chung-Shan S Road, Taipei 100, Taiwan.
authors.forename: Yih-Sharng
authors.initials: YS
authors.lastname: Chen
authors.forename: Hsi-Yu
authors.initials: HY
authors.lastname: Yu
authors.forename: Shu-Chien
authors.initials: SC
authors.lastname: Huang
authors.forename: Kaung-Ming
authors.initials: KM
authors.lastname: Chiu
authors.forename: Tzu-Yu
authors.initials: TY
authors.lastname: Lin
authors.forename: Lin-Ping
authors.initials: LP
authors.lastname: Lai
authors.forename: Fang-Yue
authors.initials: FY
authors.lastname: Lin
authors.forename: Shoei-Shan
authors.initials: SS
authors.lastname: Wang
authors.forename: Shu-Hsun
authors.initials: SH
authors.lastname: Chu
authors.forename: Wen-Je
authors.initials: WJ
authors.lastname: Ko
mesh_terms: D000328:Adult; D000368:Aged; D001219:Aspartate Aminotransferases / Q000378:metabolism; D015415:Biomarkers / Q000097:blood; D002648:Child; D052279:Creatine Kinase, MB Form / Q000378:metabolism; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000378:metabolism; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy*; D014336:Troponin / Q000378:metabolism
chemical_list: D015415:Biomarkers; D014336:Troponin; D001219:Aspartate Aminotransferases; D052279:Creatine Kinase, MB Form