title: Extracorporeal membranous oxygenation support for acute fulminant myocarditis: analysis of a single center's experience.
abstract: OBJECTIVE
  Acute fulminant myocarditis (AFM) is a disease category that is easily neglected. Circulatory mechanical support is sometimes required for this devastating condition. We analyzed our experience in managing AFM with mechanical circulatory support.
  
  
  METHODS
  We applied extracorporeal membrane oxygenation (ECMO) as a first-line rescue for AFM. The diagnosis was mainly derived from clinical results and biopsy.
  
  
  RESULTS
  Seventy-five patients were enrolled in the age range of 29.6 ± 18.6 years and the pediatric group (< 18 years) comprised 32% (n = 24) of our patient group. Thirty-five patients (47%) underwent cardiopulmonary resuscitation (CPR) before ECMO. The indication for ECMO included high inotropic support 69% (n = 54) and continuous CPR at ECMO setup 31% (n = 23). The ECMO duration was 171 ± 121 h. Survival to discharge was 64% (n = 48), 61% in adult group, and 70.8% in pediatric group. Six patients were later bridged to ventricular assist device use (5 left ventricular assist device (LVAD) and 1 bi-ventricular assist device (BVAD)) but three died of multiple-organ failure. Three patients (4%) underwent heart transplantation and all of them survived to discharge. Resuscitation did not have a significant factor for survival. Only two patients (3%) developed late mortality due to a cardiac event.
  
  
  CONCLUSIONS
  AFM still carries high mortality rates in spite of advanced mechanical support. Most of the survivors did not require transplantation and could return to good lifestyle. Due to its simplicity and effectiveness, ECMO can be a first-line tool to rescue this group of patients.
authors.affiliation: Department of Cardiovascular Surgery, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Kang-Hong
authors.initials: KH
authors.lastname: Hsu
authors.forename: Nai-Hsin
authors.initials: NH
authors.lastname: Chi
authors.forename: Hsi-Yu
authors.initials: HY
authors.lastname: Yu
authors.forename: Chih-Hsien
authors.initials: CH
authors.lastname: Wang
authors.forename: Shu-Chien
authors.initials: SC
authors.lastname: Huang
authors.forename: Shoei-Shen
authors.initials: SS
authors.lastname: Wang
authors.forename: Wen-Je
authors.initials: WJ
authors.lastname: Ko
authors.forename: Yih-Sharng
authors.initials: YS
authors.lastname: Chen
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D002561:Cerebrovascular Disorders / Q000209:etiology; D002648:Child; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000628:therapy*; D011379:Prognosis; D006435:Renal Dialysis; D051437:Renal Insufficiency / Q000209:etiology / Q000628:therapy; D012189:Retrospective Studies; D016896:Treatment Outcome