What is the clinical evidence from this study?

Study design: Case Report. Population: Fulminant myocarditis (n=1). Intervention: ECMO and IABP. Primary outcome: Clinical recovery and hospital discharge.

December 1, 2019Open Access

Successful treatment of fulminant myocarditis in an adult in emergency department

DLDanyu LiuDalian University of Technology JXJun XuYangtze University XYXuezhong YuMedical College of Wisconsin

Key Result

Early initiation of ECMO and IABP in the emergency department successfully treated a 45-year-old man with fulminant myocarditis and cardiogenic shock, leading to hospital discharge on day 81.

Study Design

Type

Case Report (n=1)

Multicenter

Structured PICO

Does early initiation of ECMO and IABP in the emergency department improve outcomes in a patient with fulminant myocarditis and cardiogenic shock?

Population

A 45-year-old man with fulminant myocarditis and cardiogenic shock who received early ECMO and IABP in the emergency department.

Intervention

Extracorporeal membrane oxygenation (ECMO) and intra-aortic balloon pumping (IABP) initiated in the emergency department.

Outcome

Survival to hospital discharge.hard clinical

Early initiation of ECMO and IABP in the emergency department can be life-saving for patients with fulminant myocarditis and cardiogenic shock.

Abstract

RATIONALE: Fulminant myocarditis (FM) has poor prognosis and the usual treatment is inotropes and symptomatic support. The initiation of extracorporeal membrane oxygenation (ECMO) and intra-aortic balloon pumping (IABP) in the emergency department (ED) is a rare event. PATIENT CONCERNS: We report the case of a 45-year-old man with a complaint of 4 days of high fever and dry cough in the emergency department. DIAGNOSIS: Transthoracic echocardiogram and the medical history showed presumptive diagnosis was fulminant myocarditis with cardiogenic shock. INTERVENTIONS: The patient's condition deteriorated drastically and ECMO was initiated immediately after admission. He experienced electrical storm twice during ECMO support and was successfully treated with the combination with IABP. OUTCOMES: ECMO and IABP were continued for 11 and 14 days respectively. The patient was discharged on the 81th day after admission, with all his laboratory tests returned to normal. LESSONS SUBSECTIONS: The early initiation of ECMO and IABP in the ED is potentially life-saving for suitable patients with FM. It appears promising but has not yet been routinely implemented in underdeveloped and developing countries.

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