Rescue for acute myocarditis with shock by extracorporeal membrane oxygenation

Background. Acute myocarditis (AM) complicated with refractory cardiogenic shock carries a very high mortality. We report our experience in treating these patients, who were rescued by extracorporeal membrane oxygenation (ECMO) and intravenous immunoglobulin. Methods. Over a 5-year period, 5 patients with AM were rescued with ECMO in our hospital. Femoral venoarterial ECMO was performed in 4 patients, and right atrium-left atrium-aorta ECMO in the other 1 due to ventricular dysfunction. Hemofiltration was applied to 3 patients. Marked elevated creatine kinase, its MB form, and troponin T (TnT) were found before ECMO. Results. All the patients could be weaned off the ECMO after 140.0 ± 57.7 hours of ECMO support. One patient died of multiple organ failure 10 days later after removal of ECMO, resulting in a 20% mortality. Renal function returned to normal in all survivors. The 4 survivors were discharged uneventfully in 23.3 ± 8.3 days and resumed functional class I status. The TnT level declined to the low level within 3 days (slope −4.94 ± 1.18 ng/mL/day), and might be an indicator of good recovery of myocardium. Conclusions. ECMO can provide an effective and simple treatment for critical AM with a satisfactory result and reduce the possibility of progressive cardiomyopathy.