Extracorporeal Cardiopulmonary Resuscitation as a Bridge to Cardiac Transplantation in Refractory Cardiac Arrest Due to Fulminant Myocarditis: A Case Report.
Lajos Szentgyorgyi, Laura Roberts, Wesley Cheung et al.
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Case in brief
A previously healthy 36-year-old woman presented with fulminant myocarditis and cardiogenic shock, then sustained an in-hospital cardiac arrest that did not respond to conventional CPR. Bedside peripheral VA-ECMO was initiated as extracorporeal CPR, providing support until conversion to a central biventricular assist device. She was listed super-urgently and underwent successful heart transplantation from a donation-after-circulatory-death donor. She was discharged neurologically intact and remained well five months later.
What made this case unusual
ECPR served as a bridge through sequential peripheral VA-ECMO and central BiVAD support to donation-after-circulatory-death heart transplantation after refractory arrest from fulminant myocarditis.
Diagnostic / clinical pearl
In fulminant myocarditis with refractory cardiac arrest, ECPR can provide a bridge to longer-term mechanical circulatory support and transplantation when conventional CPR fails.
Why it matters
The report highlights the importance of timely leadership and coordinated multidisciplinary expertise in achieving this outcome, even when most of the team had limited ECPR experience.