title: Management and outcomes in pediatric patients presenting with acute fulminant myocarditis.
abstract: OBJECTIVE
  To investigate factors associated with mechanical circulatory support and survival in patients with acute fulminant myocarditis (AFM).
  
  
  METHODS
  Retrospective cohort of AFM patients admitted to the cardiac intensive care unit during 1996-2008. AFM was defined as distinct onset of symptoms ≤14 days before admission, rapid-onset cardiogenic shock, and normal left ventricular size. Demographic and physiological variables were compared between patients treated with extracorporeal membrane oxygenation (ECMO) and those who were not and between survivors and nonsurvivors.
  
  
  RESULTS
  Twenty patients (median age 12.7 years) met inclusion criteria. Seventeen patients (85%) survived to hospital discharge. One underwent heart transplantation. Ten (50%) patients required ECMO, and 7 (70%) of these survived. On admission, patients requiring ECMO had elevated lactate (9 vs 1 mmol/L), creatinine (0.8 vs 0.6 mg/dL), and aspartate aminotransferase (256 vs 35 IU/L) (all P < .05) and a trend towards increased incidence of dysrhythmias (80% vs 30%, P = .07). During hospitalization, non-survivors had higher peak lactate (10 vs 3 mmol/L), creatinine (1.5 vs 0.8 mg/dL), and aspartate aminotransferase (3007 vs 156 IU/L) (all P < .05) compared with survivors.
  
  
  CONCLUSIONS
  Patients with AFM with end organ dysfunction or arrhythmias on admission may require mechanical circulatory support. The transplant-free survival rate in this critically ill cohort was excellent (80%).
authors.affiliation: Department of Cardiology, Children's Hospital Boston, Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA. sarah.teele@cardio.chboston.org
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Teele
authors.forename: Catherine K
authors.initials: CK
authors.lastname: Allan
authors.forename: Peter C
authors.initials: PC
authors.lastname: Laussen
authors.forename: Jane W
authors.initials: JW
authors.lastname: Newburger
authors.forename: Kimberlee
authors.initials: K
authors.lastname: Gauvreau
authors.forename: Ravi R
authors.initials: RR
authors.lastname: Thiagarajan
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D001219:Aspartate Aminotransferases / Q000097:blood; D002648:Child; D002675:Child, Preschool; D003404:Creatinine / Q000097:blood; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D016027:Heart Transplantation / Q000706:statistics & numerical data; D006353:Heart-Assist Devices; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007155:Immunologic Factors / Q000627:therapeutic use; D007223:Infant; D007231:Infant, Newborn; D019344:Lactic Acid / Q000097:blood; D008297:Male; D009205:Myocarditis / Q000175:diagnosis / Q000401:mortality* / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D009206:Myocardium / Q000473:pathology; D012189:Retrospective Studies; D016019:Survival Analysis
chemical_list: D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors; D019344:Lactic Acid; D003404:Creatinine; D001219:Aspartate Aminotransferases