Successful Role of Early V-A ECMO in Refractory Cardiogenic Shock due to Acute Enteric Myocarditis in a Young Child

Background: Sepsis is a global healthcare challenge caused by the dysregulation of the host's response to infection.Extracorporeal membrane oxygenation (ECMO) has been utilized for decades and is considered a last-resort support for neonatal and pediatric patients with septic shock.Studies show survival rates of up to 90% in septic shock, with estimated mortality rates exceeding 60%.Venoarterial ECMO (V-A ECMO) serves as an advanced life support system for cardiogenic shock, providing temporary assistance to bridge the time needed for recovery, permanent assist, or transplantation in patients at high risk of mortality.Blood is drawn from a major vein and oxygenated through an artificial lung before being returned to the body via an artery or vein through a centrifugal pump.Myocarditis, an inflammation of the myocardium, presents with a wide spectrum of clinical manifestations ranging from asymptomatic cases to cardiogenic shock.The incidence of myocarditis in enteric fever has been reported to range between 1 and 5%.Case description: We report the case of a previously healthy 14-year-old boy who presented with fever, abdominal pain, diarrhea, and vomiting.Upon initial evaluation, he was found to be in cardiogenic shock and was started on antibiotics and inotropes.Electrocardiogram and echocardiography confirmed myocarditis [left ventricular ejection fraction (LVEF) of 16-18%] with severe mitral regurgitation.As he failed to improve with high-dose inotropes, V-A ECMO was initiated.Results: Venoarterial ECMO support was gradually weaned off after 72 hours.Inotropic support and mechanical ventilation were progressively reduced.A follow-up echocardiogram showed an improved LVEF of 36%.The child is currently thriving with normal cardiac function.