Children with fulminant myocarditis rescued with extracorporeal membrane oxygenation: Figure 1

Fulminant myocarditis (FM) is characterised by a rapid onset of heart failure, usually following a flu-like illness.1 Intensive cardiovascular support including mechanical assist devices can be lifesaving; however, reports of experience with providing mechanical circulatory support to paediatric patients with FM is quite limited.2 In addition, the clinical presentation has rarely been described in detail. We report our experience treating paediatric patients with FM who were rescued by the use of extracorporeal membrane oxygenation (ECMO) during the acute stage of the illness. We describe their clinical courses and treatment strategies in detail. From June 1997 to March 2005, nine children (three boys and six girls with a mean age of 9.1 (SD 3.3) years, range 5–15 years) with FM were identified in our institute. Each patient had a clinical picture compatible with FM and had ECMO instituted because of a clinical presentation of imminently lethal cardiogenic shock, pulseless ventricular arrhythmia or cardiac arrest. The ECMO circuit consisted of a centrifugal pump and a hollow-fibre, microporous-membrane oxygenator with an integrated heater (CB2505; Medtronic Inc, Anaheim, California, USA), similar to the rapid deployment ECMO that was described by Jacobs et al .3 The ECMO pump blood flow was started initially at 50–70 ml/kg/min. …