Fulminant myocarditis is a rare and severe form of acute myocarditis and a recognised cause of cardiogenic shock. When first-line measures fail to achieve the required haemodynamic response, a structured escalation pathway guides the next step.
This protocol applies to patients with acute myocarditis presenting as fulminant myocarditis complicated by cardiogenic shock — among the most critical presentations in this disease.
First-line management comprised inotropic or vasopressor support, with an intra-aortic balloon pump (IABP) as initial mechanical circulatory support in cardiogenic shock, alongside corticosteroids in non-infectious forms and specific immunosuppressive therapy where biopsy findings indicated.
When first-line circulatory support proves insufficient, the approach involves escalation to more powerful forms of temporary mechanical circulatory support. The complete protocol — covering specific device selection, deployment criteria, and the full decision pathway — is available via the link below.
DOI: 10.1093/eurheartj/ehaf192
Fulminant myocarditis is a rare and severe presentation of myocarditis and a cause of cardiogenic shock, and should be treated accordingly with inotropic or vasopressor support or, if needed, MCS (see Section 6.3).
Among temporary MCS, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) represents the most frequently applied or recommended approach, ranging from 75% to 85% of AM cases.
Temporary MCS should be performed early and in a timely manner in patients with FM with refractory cardiogenic shock because of the high likelihood of recovery.
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