Bridging fulminant myocarditis patients to recovery or advanced therapies with veno-arterial extracorporeal membrane oxygenation: a single-center retrospective study

Fulminant myocarditis (FM) is a severe inflammatory cardiac disease, typically triggered by viral pathogens or autoimmune disorders. [1,2]Early symptoms of the disease can be mild and nonspecific, but in certain cases, patients may experience sudden and severe heart failure, arrhythmias, refractory cardiogenic shock, or even death. [3]For FM patients, especially those with concurrent cardiogenic shock, mechanical circulatory support (MCS) is vital for treatment.Among the various MCS modalities, veno-arterial extracorporeal membrane oxygenation (V-A ECMO) has been widely used in FM patients. [4]V-A ECMO can promote hemodynamic stability, maintain perfusion of end organs, [5] assist FM patients through the crisis of illness, and bridge them to recovery or further treatment.Myocarditis patients using V-A ECMO had relatively better outcomes than those with other etiologies of cardiogenic shock. [6,7]owever, for some FM patients, MCS may serve as a temporary measure, possibly necessitating subsequent heart transplantation (HTx) or ventricular assist device (VAD) implantation.Moreover, the use of ECMO as a bridging therapy for FM in China is still in its infancy, with relatively limited experience. [8]Therefore, this study aimed to summarize the practical experience of our center in applying ECMO treatment to support patients with FM, with the hope of providing insights for future treatments.This study included adult patients (≥ 18 years old) diagnosed with FM who received V-A ECMO support at Fuwai Hospital between January 2016 and August 2022.The diagnosis of myocarditis was established based