Key result
ECMELLA support bridges fulminant H1N1 perimyocarditis with arrest to full recovery and ~66% LVEF.
Why the study?
Fulminant perimyocarditis is an uncommon cause of cardiogenic shock and refractory cardiac arrest, and this report describes a case associated with Influenza A (H1N1) managed with a stepwise extracorporeal resuscitation strategy.
Case Report (n=1)
No
This case demonstrates that rapid escalation to combined VA-ECMO and Impella CP (ECMELLA) during automated CPR can successfully bridge patients with fulminant Influenza A (H1N1) perimyocarditis and refractory cardiac arrest to complete myocardial and neurological recovery.
Answers are grounded in this paper and cite their sources.
May support extracorporeal strategies in refractory perimyocarditis arrest; leaves open efficacy in viral cases.
Background: Fulminant perimyocarditis is an uncommon cause of cardiogenic shock and refractory cardiac arrest. We describe Influenza A (H1N1)-associated perimyocarditis managed with a stepwise extracorporeal resuscitation strategy. Case: A 54-year-old woman presented with chest pain, hypoxemia, and cardiogenic shock. Electrocardiography (ECG) showed diffuse ST-segment elevation. Echocardiography revealed severe biventricular dysfunction and a fibrinous pericardial effusion and coronary angiography excluded obstructive disease. Despite vasoactive support and mechanical circulatory support with microaxial flow pump Impella CP (flow 2.7 L/min.), she deteriorated to Society for Cardiovascular Angiography and Interventions (SCAI) Stage E with pulseless electrical activity (PEA). During automated chest compressions, mechanical circulatory support with femoral Impella CP was rapidly escalated to venoarterial extracorporeal membrane oxygenation (VA-ECMO). Respiratory polymerase chain reaction (PCR) was positive for Influenza A (H1N1) virus. Antiviral therapy, heparin anticoagulation, ventilation, and organ support were instituted. Hemodynamics stabilized, lactate cleared, and neurological examination after decannulation was intact. Progressive myocardial recovery permitted VA-ECMO explant on Day 3 and Impella CP removal 24 h thereafter. She was extubated on Day 6 and discharged from intensive care unit (ICU) on Day 10. Cardiac magnetic resonance (CMR) imaging confirmed myocarditis; echocardiography at follow-up showed preserved biventricular function. Conclusion: In fulminant perimyocarditis with refractory arrest, rapid activation of an extracorporeal cardiopulmonary resuscitation (ECPR) pathway with early VA-ECMO-combined with ventricular unloading-can bridge to myocardial recovery and favorable neurological outcome. Regional systems enabling safe transfer under continuous cardiopulmonary resuscitation (CPR) are critical.
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Marchetti et al. (2026) conducted a case report in Fulminant Influenza A (H1N1) perimyocarditis with cardiogenic shock and refractory cardiac arrest (n=1). Extracorporeal cardiopulmonary resuscitation with venoarterial extracorporeal membrane oxygenation (VA-ECMO) and microaxial flow pump (ECMELLA), automated mechanical chest compressions, and oseltamivir was evaluated on Myocardial recovery (LVEF) and neurological outcome at 6 months. ECMELLA support (VA-ECMO plus Impella CP) bridged a 54-year-old woman with H1N1 perimyocarditis and arrest to full recovery (LVEF 20% to 66%), VA-ECMO explant on Day 3, and intact 6-month survival.
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