VA-ECMO support in children with acute fulminant myocarditis resulted in a 50% survival to discharge rate, with non-survivors exhibiting higher pre-ECMO vasoactive drug requirements.
Observational (n=10)
No
VA-ECMO is an effective rescue therapy for children with fulminant myocarditis, achieving a 50% survival rate, though it is associated with significant complications and worse prognosis in those with higher pre-ECMO vasoactive requirements and CK-MB levels.
Fulminant myocarditis in children represents a critical cardiac emergency characterized by rapid hemodynamic collapse, for which ECMO serves as a vital rescue therapy. To describe the clinical outcomes and explore potential factors associated with prognosis of extracorporeal membrane oxygenation (ECMO) in children with acute fulminant myocarditis (AFM). This retrospective case series analyzed 10 children with AFM who received veno-arterial ECMO (VA-ECMO) support in our Pediatric Intensive Care Unit (PICU) from January 2023 to June 2025. Based on final outcome, patients were divided into a survival group ( n = 5) and a death group ( n = 5). Descriptive comparisons in pre-ECMO baseline characteristics, ECMO parameters, and complications were made between groups. At 24 h after ECMO initiation, mean arterial pressure (MAP) increased from 46.95 mmHg to 69.5 mmHg, blood lactate (Lac) decreased from 7.75 mmol/L to 2.2 mmol/L, and the vasoactive-inotropic score (VIS) decreased from 70 to 15.5. The most common complications were acute kidney injury (7 cases, 70%), septic shock (6 cases, 60%), bloodstream infection (4 cases, 40%), and intracranial complications (3 cases, 30%). The overall survival to discharge rate was 50%. In this cohort, the death group appeared to have higher pre-ECMO VIS 110 vs. 30 and CK-MB levels 191 vs. 47 U/L, as well as longer ECMO support duration 523 vs. 110 h compared to the survival group. VA-ECMO can rapidly stabilize refractory cardiogenic shock in children with AFM, but it is associated with a high incidence of complications. Higher pre-ECMO vasoactive drug requirement, higher CK-MB levels, and longer ECMO support duration may be associated with poor prognosis, although larger studies are required to confirm these observations. Optimizing ECMO initiation timing and strengthening complication prevention and multi-organ support are key to improving outcomes.
Feng et al. (Wed,) conducted a observational in Acute fulminant myocarditis (n=10). Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) was evaluated on Survival to discharge. VA-ECMO support in children with acute fulminant myocarditis resulted in a 50% survival to discharge rate, with non-survivors exhibiting higher pre-ECMO vasoactive drug requirements.