Combined intraaortic balloon counterpulsation and extracorporeal membrane oxygenation in 2 patients with fulminant myocarditis

Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is an effective treatment for fulminant myocarditis (FM). However, VA-ECMO has a limited ability to facilitate left ventricular unloading. Therefore, increased afterload is still a significant concern, especially for those with diffuse myocardial damage and serious left ventricular dysfunction. To our knowledge, there is no report concerning the use of these therapies to treat FM in China. This study investigates the efficacy of using intraaortic balloon counterpulsation to facilitate left ventricular unloading in patients treated with VA-ECMO. Here, we present 2 novel cases of Chinese women with FM treated with ECMO combined with intraaortic balloon counterpulsation. Both patients responded to treatment with improved pulsatile perfusion and left ventricular unloading. The first patient had a complete recovery and exhibited normal heart function after 2 years. Blood flow perfusion returned to normal in the second patient; however, complications stemming from a hematogenous infection led to patient death. We found that the combined therapy induced pulsatile perfusion and sufficient left ventricular unloading and that the combined therapy was an effective treatment for FM patients with electrical storm and left ventricular blood flow stasis. However, the combined therapy may increase the risk of catheter-related bloodstream infections.