ABSTRACT 505

Abstract

Background and aims: Extracorporeal Membrane Oxygenation (ECMO) is an effective therapy for otherwise fatal cases of acute fulminant myocarditis. Aims: Experience from the paediatric ECMO tertiary centre in Hong Kong is reviewed Methods: Retrospective case review in Queen Mary Hospital, Hong Kong. Results: From year 2004 to 2013, 14 cases of acute fulminant myocarditis were supported by ECMO. There were 2 boys and 12 girls with age ranges from 5 to 16 years old (median 8.5years old). All patients had a rapidly deteriorating course with arrhythmia and cardiogenic shock. Six patients had received cardiorespiratory resuscitation (CPR) before ECMO. Duration of ECMO ranges from 4 to 9 days (median 5.5days). Twelve patients survived (85%), including two patients who were switched to ventricular assist device, one of whom subsequently underwent heart transplantation and the other recovered. One patient who had received CPR before ECMO was diagnosed brain death after successfully taken off ECMO support. One patient was diagnosed brain death after mechanical oxygenator failure. Bleeding is the commonest complication that occurs in ten patients, with one patient suffering from intracranial haemorrhage. Concomitant renal replacement therapy was required in four patients. Two of five patients with femoral access developed lower limb ischaemia and required changing to central access. All patients had normal myocardial function and class I functional status upon follow up, except for one patient who suffered from neurological sequelae. Conclusions: ECMO is effective treatment for acute fulminant myocarditis. Early initiation before cardiac arrest may increase likelihood of survival. Central access is more reliable in our paediatric experience.