Complete Neurodevelopmental and Cardiac Recovery After Prolonged Cardiac Arrest With Extracorporeal Resuscitation: A Case Report

Acute fulminant myocarditis (AFM) is characterized by severe myocardial inflammation associated with cardiogenic shock, cardiac arrest, and a high mortality risk. Early extracorporeal life support (ECLS) can improve survival but also carries the risk of serious complications. We present the case of a two-year-old female patient admitted with AFM and cardiogenic shock. While preparations were underway to initiate ECLS, she suffered a sudden cardiac arrest. The patient underwent extracorporeal cardiopulmonary resuscitation (ECPR) for 27 minutes. She remained in a state of myocardial stunning for the next two days. Her clinical course was further complicated by the development of a large intracardiac thrombus, which required systemic thrombolysis with alteplase and anticoagulation therapy. She progressed to multiorgan failure, fluid overload, and rhabdomyolysis, necessitating continuous renal replacement therapy (CRRT). The patient remained on ECLS for 20 days and CRRT for seven weeks. Despite a prolonged and complex course, she was ultimately discharged home with an excellent neurodevelopmental outcome and a complete cardiac recovery. This case highlights key factors that may contribute to improved outcomes in pediatric patients with AFM requiring ECPR and ECLS.