title: Favourable clinical outcome in patients with cardiogenic shock due to fulminant myocarditis supported by percutaneous extracorporeal membrane oxygenation.
abstract: OBJECTIVE
  The clinical outcome of severe acute myocarditis patients with cardiogenic shock who require circulatory support devices is not well known. We studied the survival and clinical courses of patients with fulminant myocarditis supported by percutaneous extracorporeal membrane oxygenation (ECMO) and compared them with those of patients with acute non-fulminant myocarditis.
  
  
  RESULTS
  Patients with acute myocarditis were divided into the following two groups. Fourteen patients who required ECMO for cardiogenic shock were defined as having fulminant myocarditis (F group), whereas 13 patients who had an acute onset of symptoms, but did not have compromised, were defined as having acute non-fulminant myocarditis (NF group). In the F group, 10 patients were weaned successfully from percutaneous ECMO. Therefore, the overall acute survival rate was 71%. Patients who were not weaned from ECMO showed smaller left ventricular end-diastolic and end-systolic dimensions, thicker left ventricular wall, and higher creatine phosphokinase MB isoform levels than those who were weaned from ECMO. When compared with patients in the NF group, the fractional shortening in the F group was more severely decreased in the acute phase [F: 10+/-4 vs. NF: 23+/-8% (mean+/-SD), P<0.001], but recovered in the chronic phase (F: 33+/-7 vs. NF: 34+/-6%). The prevalence of adverse clinical events in both groups was similar during the follow-up period of 50 months.
  
  
  CONCLUSIONS
  In patients with fulminant myocarditis, percutaneous ECMO is a highly effective form of a haemodynamic support. Once a patient recovers from inflammatory myocardial damage, the subsequent clinical outcome is favourable, similar to that observed in patients with acute non-fulminant myocarditis.
authors: Division of Cardiology and Cardiovascular Surgery, National Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka 565-0873, Japan.
authors: Yasuhide
authors: Y
authors: Asaumi
authors: Satoshi
authors: S
authors: Yasuda
authors: Isao
authors: I
authors: Morii
authors: Hiroyuki
authors: H
authors: Kakuchi
authors: Yoritaka
authors: Y
authors: Otsuka
authors: Atsushi
authors: A
authors: Kawamura
authors: Yoshikado
authors: Y
authors: Sasako
authors: Takeshi
authors: T
authors: Nakatani
authors: Hiroshi
authors: H
authors: Nonogi
authors: Shunichi
authors: S
authors: Miyazaki
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D001243:Assisted Circulation / Q000379:methods; D016022:Case-Control Studies; D016638:Critical Illness; D004452:Echocardiography / Q000379:methods; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000150:complications* / Q000503:physiopathology; D012770:Shock, Cardiogenic / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000150:complications