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Peer-reviewedCC BY 4.0Case Reports in Critical Care

Extracorporeal Cardiopulmonary Resuscitation With Ventricular Unloading in Fulminant Influenza A (H1N1) Perimyocarditis: A Case Report

  • Maria Francesca Marchetti1
  • Flavio Frau2
  • Gianfranco De Candia1
  • Emiliano Maria Cirio3
  • Mauro Cadeddu1
  • Michele Porcu4
  • Roberta Montisci1
4 affiliations
  1. 1Clinical Cardiology and Cardiac Intensive Care Unit Department of Medical Sciences and Public Health University Hospital of Cagliari Cagliari Italy
  2. 2Cardiac Anesthesia Unit Department of Cardiothoracic and Vascular Sciences ARNAS G. Brotzu Cagliari Italy
  3. 3Cardiac Surgery Unit Department of Cardiothoracic and Vascular Sciences ARNAS G. Brotzu Cagliari Italy
  4. 4Department of Radiology University Hospital of Cagliari Cagliari Italy
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Abstract

Background: Fulminant perimyocarditis is an uncommon cause of cardiogenic shock and refractory cardiac arrest. We describe Influenza A (H1N1)–associated perimyocarditis managed with a stepwise extracorporeal resuscitation strategy.

Case: A 54‐year‐old woman presented with chest pain, hypoxemia, and cardiogenic shock. Electrocardiography (ECG) showed diffuse ST‐segment elevation. Echocardiography revealed severe biventricular dysfunction and a fibrinous pericardial effusion and coronary angiography excluded obstructive disease. Despite vasoactive support and mechanical circulatory support with microaxial flow pump Impella CP (flow 2.7 L/min.), she deteriorated to Society for Cardiovascular Angiography and Interventions (SCAI) Stage E with pulseless electrical activity (PEA). During automated chest compressions, mechanical circulatory support with femoral Impella CP was rapidly escalated to venoarterial extracorporeal membrane oxygenation (VA‐ECMO). Respiratory polymerase chain reaction (PCR) was positive for Influenza A (H1N1) virus. Antiviral therapy, heparin anticoagulation, ventilation, and organ support were instituted. Hemodynamics stabilized, lactate cleared, and neurological examination after decannulation was intact. Progressive myocardial recovery permitted VA‐ECMO explant on Day 3 and Impella CP removal 24 h thereafter. She was extubated on Day 6 and discharged from intensive care unit (ICU) on Day 10. Cardiac magnetic resonance (CMR) imaging confirmed myocarditis; echocardiography at follow‐up showed preserved biventricular function.

Conclusion: In fulminant perimyocarditis with refractory arrest, rapid activation of an extracorporeal cardiopulmonary resuscitation (ECPR) pathway with early VA‐ECMO—combined with ventricular unloading—can bridge to myocardial recovery and favorable neurological outcome. Regional systems enabling safe transfer under continuous cardiopulmonary resuscitation (CPR) are critical.

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Cite

BibTeXRIS
BibTeX
@article{marchetti2026extracorporeal,
  title = {{Extracorporeal Cardiopulmonary Resuscitation With Ventricular Unloading in Fulminant Influenza A (H1N1) Perimyocarditis: A Case Report}},
  author = {Maria Francesca Marchetti and Flavio Frau and Gianfranco De Candia and Emiliano Maria Cirio and Mauro Cadeddu and Michele Porcu and Roberta Montisci},
  journal = {Case Reports in Critical Care},
  year = {2026},
  month = oct,
  doi = {10.1155/crcc/6129145},
  url = {https://doi.org/10.1155/crcc/6129145},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Extracorporeal Cardiopulmonary Resuscitation With Ventricular Unloading in Fulminant Influenza A (H1N1) Perimyocarditis: A Case Report
AU  - Maria Francesca Marchetti
AU  - Flavio Frau
AU  - Gianfranco De Candia
AU  - Emiliano Maria Cirio
AU  - Mauro Cadeddu
AU  - Michele Porcu
AU  - Roberta Montisci
PY  - 2026
DA  - 2026/10/31
JO  - Case Reports in Critical Care
DO  - 10.1155/crcc/6129145
UR  - https://doi.org/10.1155/crcc/6129145
AB  - Background: Fulminant perimyocarditis is an uncommon cause of cardiogenic shock and refractory cardiac arrest. We describe Influenza A (H1N1)–associated perimyocarditis managed with a stepwise extracorporeal resuscitation strategy.  Case: A 54‐year‐old woman presented with chest pain, hypoxemia, and cardiogenic shock. Electrocardiography (ECG) showed diffuse ST‐segment elevation. Echocardiography revealed severe biventricular dysfunction and a fibrinous pericardial effusion and coronary angiography excluded obstructive disease. Despite vasoactive support and mechanical circulatory support with microaxial flow pump Impella CP (flow 2.7 L/min.), she deteriorated to Society for Cardiovascular Angiography and Interventions (SCAI) Stage E with pulseless electrical activity (PEA). During automated chest compressions, mechanical circulatory support with femoral Impella CP was rapidly escalated to venoarterial extracorporeal membrane oxygenation (VA‐ECMO). Respiratory polymerase chain reaction (PCR) was positive for Influenza A (H1N1) virus. Antiviral therapy, heparin anticoagulation, ventilation, and organ support were instituted. Hemodynamics stabilized, lactate cleared, and neurological examination after decannulation was intact. Progressive myocardial recovery permitted VA‐ECMO explant on Day 3 and Impella CP removal 24 h thereafter. She was extubated on Day 6 and discharged from intensive care unit (ICU) on Day 10. Cardiac magnetic resonance (CMR) imaging confirmed myocarditis; echocardiography at follow‐up showed preserved biventricular function.  Conclusion: In fulminant perimyocarditis with refractory arrest, rapid activation of an extracorporeal cardiopulmonary resuscitation (ECPR) pathway with early VA‐ECMO—combined with ventricular unloading—can bridge to myocardial recovery and favorable neurological outcome. Regional systems enabling safe transfer under continuous cardiopulmonary resuscitation (CPR) are critical.
SN  - 2090-6420
SN  - 2090-6439
ER  -