title: Extracorporeal life support can be a first-line treatment in children with acute fulminant myocarditis.
abstract: The clinical outcome of children with severe acute myocarditis who require mechanical circulatory support is not well known. Therefore, we studied the survival and clinical courses of patients with acute fulminant myocarditis supported by extracorporeal life support (ECLS).
  
  
  
  We performed a retrospective chart review of 13 consecutive children with acute fulminant myocarditis who were treated with ECLS between April 2013 and April 2015. Demographics, initial symptoms, laboratory results, management, clinical courses and last follow-up status were investigated.
  
  
  
  The median age was 25.8 months (range, 2.9 months to 11.5 years) and the median body weight was 10.3 kg (range, 5.3-47.5 kg). All patients received the ECLS procedure via peripheral approach (right neck). The median ECLS duration was 140 h (range, 51-425 h). The median intensive care unit stay was 16 days (range, 4-44 days). Viral pathogens were detected in 7 patients. Six patients underwent left-heart decompression using a catheter-based technique, which was performed using atrial septostomy and leaving a left atrial venting cannula. Eleven patients recovered from ventricular dysfunction, and 2 patients underwent successful orthotopic heart transplantation. Ultimately, 12 patients (92.3%) survived to discharge. The deceased patient succumbed to unrestored brain function due to enterovirus encephalitis, and the patient's parents chose to donate other organs.
  
  
  
  Mechanical circulatory support using ECLS can be a first-line treatment that confers excellent clinical outcomes for children with acute fulminant myocarditis.
authors.affiliation: Division of Pediatrics, Department of Pediatric Cardiology, Congenital Heart Disease Center, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Se Yong
authors.initials: SY
authors.lastname: Jung
authors.affiliation: Division of Cardiovascular Surgery, Department of Thoracic and Cardiovascular Surgery, Congenital Heart Disease Center, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea Department of Thoracic and Cardiovascular Surgery, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea babymedi@naver.com.
authors.forename: Hong Ju
authors.initials: HJ
authors.lastname: Shin
authors.affiliation: Division of Pediatrics, Department of Pediatric Cardiology, Congenital Heart Disease Center, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Jo Won
authors.initials: JW
authors.lastname: Jung
authors.affiliation: Division of Cardiovascular Surgery, Department of Thoracic and Cardiovascular Surgery, Congenital Heart Disease Center, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Han Ki
authors.initials: HK
authors.lastname: Park
authors.affiliation: Division of Cardiovascular Surgery, Department of Thoracic and Cardiovascular Surgery, Congenital Heart Disease Center, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Yu Rim
authors.initials: YR
authors.lastname: Shin
authors.affiliation: Division of Cardiovascular Surgery, Department of Thoracic and Cardiovascular Surgery, Congenital Heart Disease Center, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Young Hwan
authors.initials: YH
authors.lastname: Park
authors.affiliation: Division of Pediatrics, Department of Pediatric Cardiology, Congenital Heart Disease Center, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Nam Kyun
authors.initials: NK
authors.lastname: Kim
authors.affiliation: Division of Pediatrics, Department of Pediatric Cardiology, Congenital Heart Disease Center, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Jae Young
authors.initials: JY
authors.lastname: Choi
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009205:Myocarditis / Q000175:diagnosis / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Children; Extracorporeal life support; Myocarditis