Short- and long-term outcomes of patients receiving ECMO for fulminant myocarditis

Fulminant myocarditis (FM) is defined as acute myocardial inflammation with myocyte necrosis that rapidly progresses to severe heart failure and the onset of cardiological shock (CS). Treatment includes medical therapy, respiratory and circulatory support. 1. To describe clinical characteristics of patients hospitalized for FM who required circulatory support such as ECMO. 2. To describe the short- and long-term outcomes of these patients. It is a descriptive, retrospective, in the cardiology and cardiovascular surgery departments of Sahloul hospital, between January 2016 and August 2022. The study population was patients hospitalized in the cardiology intensive care unit (ICU) for acute myocarditis (AM) that was initially fulminant or AM that became fulminant during its progression and required the use of ECMO. Patients were included after reviewing medical records. Clinical, biological, and echographic follow-up was performed at 3 months and at one year. In all, 16 patients were included. The mean age was 14.1 ± 9.8 years with a female predominance (62.5%). A total of 68.8% patients were admitted in CS. On ECG: one patient was presented with VT and another with complete AVB. All patients had repolarization disorders. On TTE: the mean LVEF was 22 ± 8.2%, RV systolic dysfunction in 31.3%. Cardiac MRI was performed in 4 patients confirming the diagnosis of AM. Scorpion envenomation (SE) was the most etiology found in 62.5%, the others patients had viral myocarditis. For patients who reported SE, 11 patients were admitted in CS. In all, 43.8% of patients required hemodiafiltration. Dobutamine was prescribed in 93.8%. Twenty-five percent patients had a cardiac arrest that was recovered before ECMO. ECMO was initiated 28 hours after admission. ECMO lasted on average 6.5 days.37.5% of patients died the 8th day. The length of stay in ICU was 12 days. A TTE after ECMO withdrawal was performed in all surviving patients (10 patients), in whom an improvement in LVEF was noted, becoming 49%. Systolic function of the RV was preserved in all patients. At discharge, 62.5% of patients were put on ACE inhibitors, 43.8% on beta-blockers. At the 3-month visit, no patient died. Sixty-three were asymptomatic. At TTE, an improvement in LVEF was noted, becoming 51%. No patient died at 1-year follow-up. In all, 87.5% were asymptomatic. At the 1-year TTE, an improvement in LVEF was noted, becoming 62%. FM is a serious and rare pathology. Scorpion envenomation was the most frequent etiology of FM in our series. After ECMO, long-term follow-up showed a progressive restoration of LVEF.