Influence of confirmed viral infection on adult acute fulminant myocarditis supported with extracorporeal membrane oxygenation

Lan Pin Kuo, Meng Ta Tsai, Yi Chen Wang, Chih Hsin Hsu, Wei Hung Lin, Wei Ming Wang, Chao Jung Shih, Pei Ni Yang, Yu Ning Hu, Jun Neng Roan

Research output: Contribution to journalArticlepeer-review


Background: The impact of etiologies of acute fulminant myocarditis (AFM), which requires extracorporeal membrane oxygenation (ECMO), on clinical outcomes remains unknown. This study aimed to investigate the risk factors for ECMO weaning and mortality among patients with AFM due to viral etiologies in a tertiary referral medical center. Methods: We included 33 adults with AFM who received ECMO and were admitted between January 2002 and January 2021. General demographics, laboratory data, echocardiography findings, and long-term outcomes were analyzed for confirmed viral etiology and unconfirmed etiology groups. Results: The overall hospital survival rate was 54.5%. The age, sex, severity of the hemodynamic condition, and cardiac rhythm were similar between the two groups. Multivariate Cox regression analysis revealed that a confirmed viral etiology (HR 4.201, 95% CI 1.061–16.666), peri-ECMO renal replacement therapy (RRT) (HR 9.804, 1.140–83.333) and a high positive end-expiratory pressure (PEEP) in the ventilator settings at 24 h after ECMO (HR 1.479, 1.020–2.143) were significant prognostic factors for in-hospital mortality. Peri-ECMO RRT was also a significant negative prognostic factor for successful ECMO weaning (OR 0.061, 0.006–0.600) in the multivariate logistic model. Conclusions: Among AFM patients receiving ECMO support, RRT use was associated with a decreased chance of survival to ECMO weaning. Multiple organ dysfunction and a high PEEP were also predictive of a lower chance of hospital survival. Those with a confirmed diagnosis of viral myocarditis may require more medical attention due to the higher risk of hospital mortality than those without a definite diagnosis.

Original languageEnglish
Pages (from-to)396-407
Number of pages12
JournalArtificial Organs
Issue number2
Publication statusPublished - 2023 Feb

All Science Journal Classification (ASJC) codes

  • Bioengineering
  • Medicine (miscellaneous)
  • Biomaterials
  • Biomedical Engineering


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