To investigate the safety and efficacy of extracorporeal membrane oxygenation (ECMO) combined with intra-aortic balloon pumping (IABP) in the treatment of fulminant myocarditis.

The clinical date of 22 patients with fulminant myocarditis treated by ECMO admitted to Xuzhou Central Hospital from September 2015 to March 2022 were retrospectively analyzed. According to whether they underwent IABP or not, 22 patients were divided into an ECMO group (n = 5) and an ECMO combined with IABP group (n = 17). The hemodynamic and cardiac function changes, mechanical circulation assistance time, prognosis and complications were compared between the two groups.

Six of the 22 patients with fulminant myocarditis occurred cardiac arrest, and the cardiopulmonary resuscitation time before ECMO was 2-32 minutes; three experienced temporary pacemaker due to third degree atrioventricular block; four underwent blood purification due to acute renal failure. Compared with the ECMO group, the mean arterial pressure increased significantly after 24 h, 48 h of ECMO support and before 2 h of weaning (t = 4.818, 2.215, 2.770; P = 0.001, 0.039, 0.012) in the ECMO combined with IABP group. The left ventricular ejection fraction increased (t = 4.566, 6.300; P = 0.001, 0.001), while the lactate (t = 2.585, 3.576; P = 0.018, 0.002), cardiac troponin (t = 2.821, 2.328; P = 0.011, 0.031) and myoglobin (t = 6.290, 2.137; P = 0.001, 0.045) decreased at 24 h and 48 h after ECMO placement in the ECMO combined with IABP group than in the ECMO group. The brain natriuretic peptide (t = 2.296, 2.654; P = 0.033, 0.015) after 48 h of ECMO placement and before 2 h of weaning and creatine kinase isoenzymes (t = 2.392, P = 0.027) at 48 h after ECMO placement all decreased significantly in the ECMO combined with IABP group than in the ECMO group. The ECMO support time [(108 ± 27) h vs. (138 ± 15) h, t = 2.326, P = 0.031], incidence of acute renal failure (1/17 vs. 3/5, P = 0.024) and incidence of multiple organ failure (0/17 vs. 2/5, P = 0.043) in the ECMO combined with IABP group significantly decreased than those in the ECMO group. There were no significant differences in the weaning success rate (15/17 vs. 4/5, P = 1.000) and discharge survival rate (13/17 vs. 4/5, P = 1.000) between the two groups.

ECMO combined with IABP can significantly improve the hemodynamics and internal environment, reduce the ECMO circulatory support time and the incidence of acute renal failure and multiple organ failure of patients with fulminant myocarditis.