Case Rep Crit Care. 2026 Oct 31;2026:6129145. doi: 10.1155/crcc/6129145. eCollection 2026.
ABSTRACT
BACKGROUND: Fulminant perimyocarditis is an uncommon cause of cardiogenic shock and refractory cardiac arrest. We describe Influenza A (H1N1)-associated perimyocarditis managed with a stepwise extracorporeal resuscitation strategy.
CASE: A 54-year-old woman presented with chest pain, hypoxemia, and cardiogenic shock. Electrocardiography (ECG) showed diffuse ST-segment elevation. Echocardiography revealed severe biventricular dysfunction and a fibrinous pericardial effusion and coronary angiography excluded obstructive disease. Despite vasoactive support and mechanical circulatory support with microaxial flow pump Impella CP (flow 2.7 L/min.), she deteriorated to Society for Cardiovascular Angiography and Interventions (SCAI) Stage E with pulseless electrical activity (PEA). During automated chest compressions, mechanical circulatory support with femoral Impella CP was rapidly escalated to venoarterial extracorporeal membrane oxygenation (VA-ECMO). Respiratory polymerase chain reaction (PCR) was positive for Influenza A (H1N1) virus. Antiviral therapy, heparin anticoagulation, ventilation, and organ support were instituted. Hemodynamics stabilized, lactate cleared, and neurological examination after decannulation was intact. Progressive myocardial recovery permitted VA-ECMO explant on Day 3 and Impella CP removal 24 h thereafter. She was extubated on Day 6 and discharged from intensive care unit (ICU) on Day 10. Cardiac magnetic resonance (CMR) imaging confirmed myocarditis; echocardiography at follow-up showed preserved biventricular function.
CONCLUSION: In fulminant perimyocarditis with refractory arrest, rapid activation of an extracorporeal cardiopulmonary resuscitation (ECPR) pathway with early VA-ECMO-combined with ventricular unloading-can bridge to myocardial recovery and favorable neurological outcome. Regional systems enabling safe transfer under continuous cardiopulmonary resuscitation (CPR) are critical.
PMID:42967102 | PMC:PMC13723315 | DOI:10.1155/crcc/6129145