Early temporary ventricular assist device intervention improves survival in fulminant myocarditis with cardiogenic shock: experience from a single centre and national cohort

Background Acute fulminant myocarditis (AFM) complicated by cardiogenic shock (CS) often leads to rapid multi-organ failure. While extracorporeal life support (ECLS) is commonly used as an initial stabilizing measure, mortality remains high, particularly in patients requiring extracorporeal cardiopulmonary resuscitation (ECPR). Temporary ventricular assist devices (VADs) offer superior organ perfusion and more physiological hemodynamics compared to ECLS. Method This retrospective study analyzed 16 AFM patients with CS who underwent VAD implantation following ECPR between December 2015 and February 2024. Clinical data, including laboratory profiles, vasopressor use, echocardiographic findings, and neurological status, were assessed. In parallel, survival outcomes from the Taiwan National Health Insurance Research Database (NHIRD) were compared among AFM patients treated with ECMO, VAD, or no mechanical circulatory support (MCS). Result Of the 16 patients, 12 survived (75%) and 10 achieved cardiac recovery. Pre-VAD pulmonary artery pressure >40 mmHg and failure to wean from epinephrine by postoperative day 1 were associated with mortality. NHIRD analysis of 1,731 myocarditis patients showed the highest 30-day survival in the VAD group (88%) compared to ECMO (52%) or no MCS (71%; p = 0.003). Conclusion AFM with CS often rapidly progresses to multi-organ failure. While ECMO provides initial circulatory support, survival remains poor once initiated. Early transition from ECMO to VAD is critical in improving survival for AFM patients with CS, particularly those receiving ECPR.