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 t hese patients, who were rescued by extracorporeal membrane oxygenation (ECM O) and intravenous immunoglobulin. Methods. Over a 5-year period, 5 patients with AM were rescued with ECMO in our hospital. Femoral veno-arterial ECMO was performed in 4 patients, and right atrium-left atrium-aorta ECMO in the other I due to ventricular dysfu nction. 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 r eturned to normal in all survivors. The 4 survivors were discharged unevent fully in 23.3 +/- 8.3 days and resumed functional class I status. The TnT l evel declined to the low level within 3 days (sfope -4.94 +/- 1.18 ng/mL/da y), and might he an indicator of good recovery of myocardium. Conclusions. ECMO can provide an effective and simple treatment for critica l AM with a satisfactory result and reduce the possibility of progressive c ardiomyopathy. (C) 1999 by The Society of Thoracic Surgeons.