Background: Acute fulminant myocarditis (AFM) is a serious disease that progresses\nrapidly, and leads to failing respiratory and circulatory systems. When medications fail to reverse\nthe patientâ??s clinical course, extracorporeal membrane oxygenation (ECMO) is considered the\nmost effective, supportive and adjunct strategy. In this paper we analyzed our experience in\nmanaging AFM with ECMO support. Methods: During October 2003 and February 2017, a total\nof 35 patients (â?¦â?¦18 years) were enrolled in the study. Twenty patients survived, and another 15\npatients expired. General demographics, the hemodynamic condition, timing of ECMO intervention,\nand laboratory data were compared for the survival and non-survival groups. Univariate and\nmultivariate Cox regression analyses were performed to identify the associations with in-hospital\nmortality following ECMO use in this situation. Results: The survival rate was 57.1% during the\nin-hospital period. The average age, gender, severity of the hemodynamic condition, and cardiac\nrhythm were similar between the survival and non-survival groups. Higher serum lactic acid (initial\nand 24 h later), higher peak cardiac biomarkers, higher incidence of acute kidney injury and the need\nfor hemodialysis were noted in the non-survival group. Higher 24-h lactic acid levels and higher peak\ntroponin-I levels were associated with in-hospital mortality. Conclusions: When ECMO was used\nfor AFM, related cardiogenic shock and decompensated heart failure, higher peak serum troponin-I\nlevels and 24-h serum lactic acid levels following ECMO use were independently associated with\nin-hospital mortality.
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