The rescue of acute fulminant myocarditis by extracorporeal membrane oxygenation in pediatric patients.

The severity of acute myocarditis varies between subclinical to lethal. For fulminant myocarditis, the mortality rate can be as high as 75% when shock occurs. Extracorporeal membrane oxygenation (ECMO) support to revert this fulminant course has been introduced into the management in recent years. Six such pediatric cases rescued with ECMO in our hospital over a 3-year period were reviewed. Femoral venoarterial cannulated ECMO was undertaken in 5 patients and right atrium and ascending aorta cannulated ECMO in one. All patients had histories and clinical findings consistent with fulminant myocarditis. Median age was 12 years old (range 9 to 14 years). Median duration of ECMO support was 61.5 hours (range 36 to 90 hours). Three patients survived. Two of them complicated with deep vein thrombosis or peripheral neuropathy. The survivors showed normal cardiac function after follow-up periods of 0.8-4.3 years. Early recognition and immediate establishment of an ECMO circuit are crucial to rescue a patient with fulminant myocarditis. Every effort to avoid the complications associated with ECMO should then be stressed.