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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Specialty: Critical Care, Emergency Medicine