Successful ECPR with Neurological Recovery in Fulminant Myocarditis: A Case Report

Background: Fulminant myocarditis is a severe and life-threatening condition often resistant to conventional treatments. This report highlights a rare case of a 40-year-old female with refractory cardiogenic shock who experienced a witnessed in-hospital cardiac arrest. Advanced interventions, including extracorporeal cardiopulmonary resuscitation (ECPR) and veno-arterial extracorporeal membrane oxygenation (V-A ECMO), resulted in intact neurological recovery. This case underscores the potential of aggressive life-support strategies in achieving favorable outcomes for fulminant myocarditis. Case Report: In our case, a 40 year old female, who was provisionally diagnosed as acute fulminant viral myocarditis in refractory cardiogenic shock had suffered a witnessed in hospital cardiac arrest was managed with Extracorporeal Cardiopulmonary resuscitation( ECPR) and revived with intact neurological status. The patient had sustained pulseless Ventricular tachycardia and Advanced Cardiac Life Support (ACLS) protocol was initiated immediately. Due to refractory ventricular fibrillation, she was initiated on Veno-Arterial Extracorporeal Membrane Oxygenation (V-A ECMO). Return Of Spontaneous Circulation (ROSC) was achieved and post cardiac arrest care was continued and her neurological status was evaluated and found to be intact. She was managed on V-A ECMO and other supportive measures and was gradually weaned off from ECMO on day 12. Elective tracheostomy was performed and gradually weaned off from the ventilator. She had right hemothorax due to persistent active bleeding from right intercostal artery and underwent right intercostal artery embolization followed by Video Assisted Thoracoscopic Surgery ( VATS). After a prolonged course of hospital stay she was discharged home with good clinical and functional status. Fulminant myocarditis is often fatal, but aggressive supportive measures with novel ECPR strategies have found to have mortality benefit with good recovery as it happened in this case. Conclusion: With a complete recovery of neurological function, this was one of the rare cases of successful ECPR for fulminant myocarditis and emphasized the potential role of VA-ECMO in treating fulminant myocarditis in cardiogenic shock. Further research should be done for our current understanding of the role of ECPR in cardiac arrest and to refine our approach to this complex endeavour.