Extracorporeal Cardiopulmonary Resuscitation in Acute Fulminant Myocarditis: A Case Report and Review of the Literature

Abstract

Fulminant myocarditis is a life-threatening fast progressive condition. We present a 7-year-old female patient admitted with a diagnosis of acute myocarditis with a rapidly progressive cardiac dysfunction despite conventional vasoactive and inotropic treatment. The patient presented with ventricular fibrillation and subsequent cardiac arrest. Cardiopulmonary resuscitation (CPR) was performed during 105 minutes before extracorporeal membrane oxygenation (ECMO) cannulation was performed. Effective hemodynamic function was obtained, and ECMO was weaned after 7 days, without neurological complications. There are not established extracorporeal cardiopulmonary resuscitation (eCPR) treatment criteria, and some international guidelines consider up to 100 minutes of "low flow" phase as a time limit to start the support. Some mortality risk factors for ECMO treatment mortality are female gender, renal failure, and arrhythmias. Pre-ECMO good prognostic factors are high levels of pH and blood lactate.

Keywords: cardiopulmonary resuscitation; extracorporeal membrane oxygenation; myocarditis; prognostic factors; risk factor.

Fig. 1

Myocardial biopsy demonstrating the following features: ( A ) Mild interstitial fibrosis and small foci of lymphocytes affecting myocardial fibers (hematoxylin-eosin; original magnification ×200). ( B ) Diffuse areas of edema, recent hemorrhage, and scattered lymphocytes surrounding myocardial fibers with hypertrophy (hematoxylin–eosin; original magnification ×200). ( C and D ) Immunoperoxidase staining for CD3, highlighting T lymphocytes in different sections of the myocardium (VENTANA Anti-CD3 [clone, 2GV6] original magnification ×1000).