title: Acute-onset dysrhythmia heralding fulminant myocarditis and refractory cardiac arrest treated with ED cardiopulmonary bypass and extracorporeal membrane oxygenation.
abstract: BACKGROUND
  The outcome of refractory cardiac arrest is poor. The purpose of this report is to describe two cases presenting with fulminant myocarditis and refractory cardiac arrest treated with emergency department cardiopulmonary bypass (CPB) and extracorporeal membrane oxygenation (ECMO), with subsequent recovery.
  
  
  METHODS
  Report of two cases.
  
  
  RESULTS
  Two patients presented with a new onset dysrhythmia heralding fulminant myocarditis and cardiac arrest refractory to advanced life support measures. Chest compressions and positive pressure ventilation maintained oxygenation and perfusion until CPB could be initiated in the ED followed by ECMO. Spontaneous cardiac recovery followed, associated with normal neurocognitive function.
  
  
  CONCLUSIONS
  While CPB and ECMO initiation in the ED is a rare event, this could provide patients with cardiac arrest presentations suggestive of myocarditis, additional time for recovery to occur. Clinical factors suggesting a good outcome are witnessed cardiac arrest in a previously healthy child with immediate initiation of effective CPR and good brain perfusion and function as evidence by substantial bodily movement during CPR. Significant dysrhythmias in a previously healthy child may herald substantial deterioration and cardiac arrest.
authors.affiliation: Department of Pediatrics, University of Hawaii John A. Burns School of Medicine, Honolulu, HI 96826, USA. loreny@hawaii.edu
authors.forename: Loren G
authors.initials: LG
authors.lastname: Yamamoto
authors.forename: Lynette L
authors.initials: LL
authors.lastname: Young
mesh_terms: D001145:Arrhythmias, Cardiac / Q000150:complications*; D002315:Cardiopulmonary Bypass; D002648:Child; D004636:Emergency Service, Hospital; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006323:Heart Arrest / Q000150:complications / Q000628:therapy*; D006801:Humans; D009205:Myocarditis / Q000150:complications*