Veno-arterial ECMO in fulminant myocarditis: a retrospective single-center case series

INTRODUCTION: Fulminant myocarditis (FM) is a life-threatening condition that may require veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Evidence from Latin America remains limited. METHODS: We conducted a retrospective case series of adult patients with FM requiring VA-ECMO support at a high-complexity center. Clinical, hemodynamic, metabolic, and echocardiographic variables were analyzed descriptively. RESULTS: This case series included 16 patients with a mean age of 39.03 years (SD 12.93), with an equal number of male and female patients. Twenty-eight-day survival was 68.75% (11/16). According to the Charlson Comorbidity Index, 70% (11/16) of the patients had a score of 0. The median survival after veno-arterial ECMO (SAVE) score was 1.5 (interquartile range [IQR] 1-3). Lactate levels and vasoactive-inotropic score (VIS) reduced from 3.79 (IQR: 1.68-8.46) mmoL/L and 68 (IQR: 54-113) pre-ECMO to 1.52 (IQR: 1.26-2.03) mmoL/L and 20 (IQR: 13-45) post-ECMO, respectively. In contrast, PaO₂/FiO₂ ratio, left ventricular ejection fraction, and fractional area change (FAC) increased from 186 (IQR: 126-245) mmHg, 16.5% (IQR: 10%-34%), and 29.5% (IQR: 19-33) pre-ECMO to 260 (IQR: 178-307) mmHg, 51.5% (IQR: 45%-55%), and 42% (IQR: 37-45) post-ECMO, respectively. Complications included renal events in 56.25% (9/16), bleeding 37.5% (6/16), cardiovascular complications in 31.25% (5/16) and infectious complications in 33.33% (5/16) of the participants. CONCLUSIONS: In this cohort of patients with FM supported with VA-ECMO, changes in hemodynamic, metabolic, and echocardiographic parameters were observed following support initiation, with survival rates comparable to prior reports.