title: Prognosis of patients with fulminant myocarditis managed by peripheral venoarterial extracorporeal membranous oxygenation support: a retrospective single-center study.
abstract: BACKGROUND
  Peripheral venoarterial extracorporeal membranous oxygenation (ECMO) support is effective in patients with cardiogenic shock or fatal arrhythmia due to fulminant myocarditis. The clinical courses of fulminant myocarditis are still uncertain; therefore, it is difficult to determine the appropriate time for discontinuing ECMO or converting to a ventricular assist device. The purpose of this study was to investigate the prognosis of patients with fulminant myocarditis managed by ECMO.
  
  
  METHODS
  Twenty-two consecutive patients with fulminant myocarditis managed by peripheral venoarterial ECMO between 1999 and 2013 were enrolled.
  
  
  RESULTS
  Survival to discharge was 59% (13 patients), and in-hospital mortality was 41% (9 patients). The age in the survivor group was significantly lower than that in the non-survivor group (survivor group vs. non-survivor group; 36.5 ± 4.1 vs. 60.2 ± 5.0 years, p = 0.001). Although the ECMO support duration was similar between the groups (181 ± 22 vs. 177 ± 31 h), the rate of complication related to ECMO was significantly lower in the survivor group (15.3% vs. 66.6%, p = 0.02). When comparing the laboratory data during ECMO management between the groups, the serum bilirubin level on day 7 was significantly lower in the survivor group (total: 4.6 ± 2.8 vs. 13.7 ± 10.8 mg/dL, p = 0.014; direct: 2.2 ± 0.5 vs. 9.8 ± 4.5 mg/dL, p = 0.009).
  
  
  CONCLUSIONS
  Fulminant myocarditis is associated with high mortality rates despite ECMO. An older age and complications related to ECMO are associated with poor prognosis.
authors.affiliation: Department of Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan ; Cardiovascular Division, Jichi Medical University Saitama Medical Center, 1-847 Amanuma, Omiya-ku, Saitama Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Nakamura
authors.affiliation: Department of Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan.
authors.forename: Kohki
authors.initials: K
authors.lastname: Ishida
authors.affiliation: Department of Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan.
authors.forename: Yousuke
authors.initials: Y
authors.lastname: Taniguchi
authors.affiliation: Department of Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan.
authors.forename: Tomu
authors.initials: T
authors.lastname: Nakagawa
authors.affiliation: Department of Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan.
authors.forename: Masaru
authors.initials: M
authors.lastname: Seguchi
authors.affiliation: Department of Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Wada
authors.affiliation: Department of Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan.
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Sugawara
authors.affiliation: Department of Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Funayama
authors.affiliation: Department of Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Mitsuhashi
authors.affiliation: Department of Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan.
authors.forename: Shin-Ichi
authors.initials: S
authors.lastname: Momomura
keywords: Extracorporeal membranous oxygenation support; Fulminant myocarditis; Prognosis