Extracorporeal Cardiopulmonary Resuscitation as a Bridge to Cardiac Transplantation in Refractory Cardiac Arrest Due to Fulminant Myocarditis: A Case Report.

Extracorporeal cardiopulmonary resuscitation (ECPR) is increasingly used for refractory cardiac arrest, although evidence for a survival benefit remains heterogeneous and appears highly dependent on patient selection and systems of care. We report the case of a previously healthy 36-year-old woman who presented with acute fulminant myocarditis and cardiogenic shock. Following an in-hospital cardiac arrest unresponsive to conventional cardiopulmonary resuscitation, bedside ECPR was initiated using peripheral veno-arterial extracorporeal membrane oxygenation (VA-ECMO) as a bridge to longer-term mechanical circulatory support with a biventricular assist device (BiVAD). After conversion to central BiVAD support, the patient was listed super-urgently and subsequently underwent successful donation-after-circulatory-death heart transplantation. She was discharged home neurologically intact and remains well five months after discharge. This case demonstrates that when deterioration is imminent and standard therapies have failed, ECPR may provide life-saving support while preparing for definitive mechanical circulatory support, even when most members of the clinical team lack ECPR experience. Timely leadership and coordinated multidisciplinary expertise were the key to achieving a successful outcome in this case.