Clin Exp Pediatr.  2021 May;64(5):188-195. 10.3345/cep.2020.00836.

The use of extracorporeal membrane oxygenation in children with acute fulminant myocarditis

Affiliations
  • 1Critical Care Research Group, Faculty of Medicine, University of Queensland and The Prince Charles Hospital, Brisbane, Australia
  • 2Paediatric Critical Care Research Group, Child Health Research Centre, The University of Queensland, Queensland, Australia
  • 3Paediatric Intensive Care Unit, Queensland Children’s Hospital, South Brisbane, Australia
  • 4Department of Pediatrics, Chonnam National University Children’s Hospital, Chonnam National University Medical School, Gwangju, Korea

Abstract

Acute fulminant myocarditis (AFM) occurs as an inflammatory response to an initial myocardial insult. Its rapid and deadly progression calls for prompt diagnosis with aggressive treatment measures. The demonstration of its excellent recovery potential has led to increasing use of mechanical circulatory support, especially extracorporeal membrane oxygenation (ECMO). Arrhythmias, organ failure, elevated cardiac biomarkers, and decreased ventricular function at presentation predict requirement for ECMO. In these patients, ECMO should be considered earlier as the clinical course of AFM can be unpredictable and can lead to rapid haemodynamic collapse. Key uncertainties that clinicians face when managing children with AFM such as timing of initiation of ECMO and left ventricular decompression need further investigation.

Keyword

Myocarditis; Myocarditis, Extracorporeal membrane oxygenation, Critical care, Child; Extracorporeal membrane oxygenation; Critical care; Child
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