Teele et al evaluated pediatric patients with acute fulminant myocarditis (AFM) who required extracorporeal membrane oxygenation (ECMO). The authors are from Children's Hospital Boston.


Criteria for acute fulminant myocarditis (AFM):

(1) onset of symptoms <= 14 days prior to hospital admission

(2) rapid onset of cardiogenic shock

(3) normal left ventricular size

(4) exclusion of other diagnoses that can explain the findings


About 50% of pediatric patients with AFM received ECMO. Heart transplantation was required in only 1 of 20 patients.


Predictors of ECMO:

(1) elevated blood lactate (lactic acidosis)

(2) elevated serum creatinine

(3) elevated serum AST

(4) cardiac dysrhythmia


Predictors of death:

(1) high peak serum lactate

(2) number of organ failures


In general the prognosis is good but the mortality rate was 15%.


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