In Taiwan over a period of almost 8 years (1997–2005) nine children aged 5–15 years were treated with extracorporeal membrane oxygenation (ECMO) for acute fulminant myocarditis (

) . Six of them survived. All nine had had a prodromal influenza-like illness and their symptoms prior to admission (vomiting, seizures or drowsiness) were not obviously of cardiac origin. Deterioration after admission was rapid (mean time to cardiovascular collapse 11 hours) and ECMO was initiated because of cardiogenic shock or cardiac arrest. In three patients ECMO was started during external cardiac massage. Two larger patients had treatment with an intraaortic balloon pump before ECMO and two needed temporary pacemakers for atrioventricular block and tachycardia. All nine patients had raised serum concentrations of cardiac enzymes before ECMO and all had wide polymorphic QRS tachycardia during ECMO. The QRS complexes narrowed as ventricular function improved and in survivors left ventricular ejection fraction improved around the fourth day. Atrioventricular block in two patients reverted to sinus rhythm after 3 days of ECMO. The mean duration of ECMO in survivors was 115 hours. The causes of death in three patients were sepsis, thrombus occlusion of the ECMO circuit, and severe brain damage after prolonged resuscitation attempts. The survivors remained in good cardiac health …