Int Heart J. 2026;67(3):228-237. doi: 10.1536/ihj.25-716.
ABSTRACT
Fulminant myocarditis (FM) is characterized by rapid hemodynamic deterioration and is often accompanied by cardiac arrest (CA). Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is frequently employed to stabilize hemodynamics or as a rescue therapy for CA. However, data regarding the prognostic implications of CA, particularly in relation to the timing and location of its occurrence, are limited.We conducted a multicenter, retrospective cohort study of 154 patients with FM who received VA-ECMO support between 2000 and 2020. We evaluated the composite outcome of death, durable left ventricular assist device, or heart transplantation up to 90 days and six years after admission.CA occurred in 62 patients. Among patients for whom the location of CA occurrence was known, 38 (74.6%) experienced in-hospital CA (IHCA), and 13 (25.4%) experienced out-of-hospital CA (OHCA). CA was associated with a high risk of the composite outcome (adjusted hazard ratio [HR], 2.24; 95% confidence interval [CI], 1.35-3.70). The IHCA and non-CA groups exhibited significant deterioration in the levels of several biomarkers, including serum lactate dehydrogenase, from the time of hospital arrival to initiation of mechanical circulatory support (MCS) compared with the OHCA group. The IHCA group demonstrated the worst prognosis, with an adjusted HR of 2.61 (95% CI, 1.50-4.53) compared with the non-CA group.In patients with FM requiring VA-ECMO, CA, particularly IHCA, showed worse outcome. These findings underscore the need for early recognition of hemodynamic deterioration and timely MCS initiation to prevent CA during hospitalization.
PMID:42219328 | DOI:10.1536/ihj.25-716