Temporary mechanical support in fulminant myocarditis: Prognostic factors and clinical implications from the FULLMOON study

Matthieu Schmidt; Maharajah Ponnaiah; Florent Huang; Santiago Montero; Victor Raimbault; Darryl Abrams; Guillaume Lebreton; Vincent Pellegrino; Joshua Ihle; Maurizio Bottiroli; Romain Persichini; M. Isabel Barrionuevo-Sánchez; Albert Ariza Solé; Pauline Yeung Ng; Simon Sin Wai Ching; Raj Ayer; Hergen Buscher; Caroline Biendel; Clément Delmas; Rita Ferreira; Roberto Roncon-Albuquerque; Jeroen J.H. Bunge; Christoph Fisser; Guillaume Franchineau; Jamie McCanny; Shinichiro Ohshimo; Alessandro Sionis; Francisco José Hernández-Pérez; Eduardo Barge-Caballero; Martin Balik; Henrique Muglia; Sunghoon Park; Dirk W. Donker; Beatriz Porral; Nadia Aïssaoui; Armand Mekontso Dessap; Virginia Burgos; Mathieu Lesouhaitier; Justin Fried; Jae-Seung Jung; Sandra Rosillo; Vincent Scherrer; Saad Nseir; Hadrien Winszewski; Pablo Jorge-Pérez; Antoine Kimmoun; Rodrigo Diaz; Guillaume Hekimian; Enrico Ammirati; Alain Combes; FULLMOON Study Group

doi:10.1007/s00134-025-08268-3

Temporary mechanical support in fulminant myocarditis: Prognostic factors and clinical implications from the FULLMOON study

Matthieu Schmidt^*
, Maharajah Ponnaiah
, Florent Huang
, Santiago Montero
, Victor Raimbault
, Darryl Abrams
, Guillaume Lebreton
, Vincent Pellegrino
, Joshua Ihle
, Maurizio Bottiroli
, Romain Persichini
, M. Isabel Barrionuevo-Sánchez
, Albert Ariza Solé
, Pauline Yeung Ng
, Simon Sin Wai Ching
, Raj Ayer
, Hergen Buscher
, Caroline Biendel
, Clément Delmas
, Rita Ferreira

Roberto Roncon-Albuquerque, Jeroen J.H. Bunge, Christoph Fisser, Guillaume Franchineau, Jamie McCanny, Shinichiro Ohshimo, Alessandro Sionis, Francisco José Hernández-Pérez, Eduardo Barge-Caballero, Martin Balik, Henrique Muglia, Sunghoon Park, Dirk W. Donker, Beatriz Porral, Nadia Aïssaoui, Armand Mekontso Dessap, Virginia Burgos, Mathieu Lesouhaitier, Justin Fried, Jae-Seung Jung, Sandra Rosillo, Vincent Scherrer, Saad Nseir, Hadrien Winszewski, Pablo Jorge-Pérez, Antoine Kimmoun, Rodrigo Diaz, Guillaume Hekimian, Enrico Ammirati, Alain Combes, FULLMOON Study Group

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Background: Temporary mechanical circulatory support (t-MCS) is increasingly used in fulminant myocarditis (FM), yet long-term outcomes and risk factors remain poorly defined.

Methods: From the FULLMOON international cohort (419 adults with suspected FM across 36 centers in 15 countries), 295 patients treated with venoarterial extracorporeal membrane oxygenation (V-A ECMO) and/or Impella were analyzed. The primary endpoint was mortality at 1 year, heart transplantation (HTx), or left-ventricular assist device (LVAD). Multivariate Cox regression identified predictors of adverse outcomes. A propensity score-weighted analysis assessed outcomes based on timing of endomyocardial biopsy (EMB): early (≤ 2 days), delayed (> 2 days), or none.

Results: The median age was 39 years (IQR 28–60), and 55% were female. Myocarditis was confirmed in 204 (69%) of the patients via histology or cardiac MRI. Histological data were available for 151 (51%) of the cohort. One-year mortality was 36%, while 44% died or had an HTx or LVAD. Predictors of worse outcomes were giant cell myocarditis, older age, cardiac arrest at ECMO initiation, and delayed EMB. Delayed EMB was consistently associated with higher mortality, HTx, or LVAD compared to early (HR = 1.55; 95% CI 1.23–1.96; p < 0.01) or no EMB (HR = 1.59; 95% CI 1.26–2.01; p < 0.01). However, event-free survival did not differ significantly between early EMB and no EMB (HR = 1.03; 95% CI 0.80–1.32; p = 0.85).

Conclusions: Despite a relatively young cohort, FM requiring t-MCS is associated with a high 1-year mortality rate. Timely recognition and early referral to specialized ECMO centers before cardiac arrest are critical.

Original language	English
Pages (from-to)	240-251
Number of pages	12
Journal	Intensive care medicine
Volume	52
Early online date	12 Jan 2026
DOIs	https://doi.org/10.1007/s00134-025-08268-3
Publication status	Published - Feb 2026

Keywords

2026 OA procedure
Endomyocardial biopsy
Fulminant myocarditis
Outcomes
Temporary mechanical support
ECMO

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10.1007/s00134-025-08268-3

Cite this

Schmidt, M., Ponnaiah, M., Huang, F., Montero, S., Raimbault, V., Abrams, D., Lebreton, G., Pellegrino, V., Ihle, J., Bottiroli, M., Persichini, R., Barrionuevo-Sánchez, M. I., Ariza Solé, A., Yeung Ng, P., Ching, S. S. W., Ayer, R., Buscher, H., Biendel, C., Delmas, C., ... FULLMOON Study Group (2026). Temporary mechanical support in fulminant myocarditis: Prognostic factors and clinical implications from the FULLMOON study. Intensive care medicine, 52, 240-251. https://doi.org/10.1007/s00134-025-08268-3

@article{bdcbd2b1feb54a8ab726e3629a462f0f,

title = "Temporary mechanical support in fulminant myocarditis: Prognostic factors and clinical implications from the FULLMOON study",

abstract = "Background: Temporary mechanical circulatory support (t-MCS) is increasingly used in fulminant myocarditis (FM), yet long-term outcomes and risk factors remain poorly defined.Methods: From the FULLMOON international cohort (419 adults with suspected FM across 36 centers in 15 countries), 295 patients treated with venoarterial extracorporeal membrane oxygenation (V-A ECMO) and/or Impella were analyzed. The primary endpoint was mortality at 1 year, heart transplantation (HTx), or left-ventricular assist device (LVAD). Multivariate Cox regression identified predictors of adverse outcomes. A propensity score-weighted analysis assessed outcomes based on timing of endomyocardial biopsy (EMB): early (≤ 2 days), delayed (> 2 days), or none.Results: The median age was 39 years (IQR 28–60), and 55\% were female. Myocarditis was confirmed in 204 (69\%) of the patients via histology or cardiac MRI. Histological data were available for 151 (51\%) of the cohort. One-year mortality was 36\%, while 44\% died or had an HTx or LVAD. Predictors of worse outcomes were giant cell myocarditis, older age, cardiac arrest at ECMO initiation, and delayed EMB. Delayed EMB was consistently associated with higher mortality, HTx, or LVAD compared to early (HR = 1.55; 95\% CI 1.23–1.96; p < 0.01) or no EMB (HR = 1.59; 95\% CI 1.26–2.01; p < 0.01). However, event-free survival did not differ significantly between early EMB and no EMB (HR = 1.03; 95\% CI 0.80–1.32; p = 0.85).Conclusions: Despite a relatively young cohort, FM requiring t-MCS is associated with a high 1-year mortality rate. Timely recognition and early referral to specialized ECMO centers before cardiac arrest are critical.",

keywords = "2026 OA procedure, Endomyocardial biopsy, Fulminant myocarditis, Outcomes, Temporary mechanical support, ECMO",

author = "Matthieu Schmidt and Maharajah Ponnaiah and Florent Huang and Santiago Montero and Victor Raimbault and Darryl Abrams and Guillaume Lebreton and Vincent Pellegrino and Joshua Ihle and Maurizio Bottiroli and Romain Persichini and Barrionuevo-S{\'a}nchez, \{M. Isabel\} and \{Ariza Sol{\'e}\}, Albert and \{Yeung Ng\}, Pauline and Ching, \{Simon Sin Wai\} and Raj Ayer and Hergen Buscher and Caroline Biendel and Cl{\'e}ment Delmas and Rita Ferreira and Roberto Roncon-Albuquerque and Teresa Lόpez-Sobrino and Bunge, \{Jeroen J.H.\} and Christoph Fisser and Guillaume Franchineau and Jamie McCanny and Shinichiro Ohshimo and Alessandro Sionis and Hern{\'a}ndez-P{\'e}rez, \{Francisco Jos{\'e}\} and Eduardo Barge-Caballero and Martin Balik and Henrique Muglia and Sunghoon Park and Donker, \{Dirk W.\} and Beatriz Porral and Nadia A{\"i}ssaoui and \{Mekontso Dessap\}, Armand and Virginia Burgos and Mathieu Lesouhaitier and Justin Fried and Jae-Seung Jung and Sandra Rosillo and Vincent Scherrer and Saad Nseir and Hadrien Winszewski and Pablo Jorge-P{\'e}rez and Antoine Kimmoun and Rodrigo Diaz and Guillaume Hekimian and Enrico Ammirati and Alain Combes and \{FULLMOON Study Group\}",

note = "Publisher Copyright: {\textcopyright} Springer-Verlag GmbH Germany, part of Springer Nature 2026.",

year = "2026",

month = feb,

doi = "10.1007/s00134-025-08268-3",

language = "English",

volume = "52",

pages = "240--251",

journal = "Intensive care medicine",

issn = "0342-4642",

publisher = "Springer",

}

Schmidt, M, Ponnaiah, M, Huang, F, Montero, S, Raimbault, V, Abrams, D, Lebreton, G, Pellegrino, V, Ihle, J, Bottiroli, M, Persichini, R, Barrionuevo-Sánchez, MI, Ariza Solé, A, Yeung Ng, P, Ching, SSW, Ayer, R, Buscher, H, Biendel, C, Delmas, C, Ferreira, R, Roncon-Albuquerque, R, Bunge, JJH, Fisser, C, Franchineau, G, McCanny, J, Ohshimo, S, Sionis, A, Hernández-Pérez, FJ, Barge-Caballero, E, Balik, M, Muglia, H, Park, S, Donker, DW, Porral, B, Aïssaoui, N, Mekontso Dessap, A, Burgos, V, Lesouhaitier, M, Fried, J, Jung, J-S, Rosillo, S, Scherrer, V, Nseir, S, Winszewski, H, Jorge-Pérez, P, Kimmoun, A, Diaz, R, Hekimian, G, Ammirati, E, Combes, A & FULLMOON Study Group 2026, 'Temporary mechanical support in fulminant myocarditis: Prognostic factors and clinical implications from the FULLMOON study', Intensive care medicine, vol. 52, pp. 240-251. https://doi.org/10.1007/s00134-025-08268-3

TY - JOUR

T1 - Temporary mechanical support in fulminant myocarditis

T2 - Prognostic factors and clinical implications from the FULLMOON study

AU - Schmidt, Matthieu

AU - Ponnaiah, Maharajah

AU - Huang, Florent

AU - Montero, Santiago

AU - Raimbault, Victor

AU - Abrams, Darryl

AU - Lebreton, Guillaume

AU - Pellegrino, Vincent

AU - Ihle, Joshua

AU - Bottiroli, Maurizio

AU - Persichini, Romain

AU - Barrionuevo-Sánchez, M. Isabel

AU - Ariza Solé, Albert

AU - Yeung Ng, Pauline

AU - Ching, Simon Sin Wai

AU - Ayer, Raj

AU - Buscher, Hergen

AU - Biendel, Caroline

AU - Delmas, Clément

AU - Ferreira, Rita

AU - Roncon-Albuquerque, Roberto

AU - Lόpez-Sobrino, Teresa

AU - Bunge, Jeroen J.H.

AU - Fisser, Christoph

AU - Franchineau, Guillaume

AU - McCanny, Jamie

AU - Ohshimo, Shinichiro

AU - Sionis, Alessandro

AU - Hernández-Pérez, Francisco José

AU - Barge-Caballero, Eduardo

AU - Balik, Martin

AU - Muglia, Henrique

AU - Park, Sunghoon

AU - Donker, Dirk W.

AU - Porral, Beatriz

AU - Aïssaoui, Nadia

AU - Mekontso Dessap, Armand

AU - Burgos, Virginia

AU - Lesouhaitier, Mathieu

AU - Fried, Justin

AU - Jung, Jae-Seung

AU - Rosillo, Sandra

AU - Scherrer, Vincent

AU - Nseir, Saad

AU - Winszewski, Hadrien

AU - Jorge-Pérez, Pablo

AU - Kimmoun, Antoine

AU - Diaz, Rodrigo

AU - Hekimian, Guillaume

AU - Ammirati, Enrico

AU - Combes, Alain

AU - FULLMOON Study Group

PY - 2026/2

Y1 - 2026/2

N2 - Background: Temporary mechanical circulatory support (t-MCS) is increasingly used in fulminant myocarditis (FM), yet long-term outcomes and risk factors remain poorly defined.Methods: From the FULLMOON international cohort (419 adults with suspected FM across 36 centers in 15 countries), 295 patients treated with venoarterial extracorporeal membrane oxygenation (V-A ECMO) and/or Impella were analyzed. The primary endpoint was mortality at 1 year, heart transplantation (HTx), or left-ventricular assist device (LVAD). Multivariate Cox regression identified predictors of adverse outcomes. A propensity score-weighted analysis assessed outcomes based on timing of endomyocardial biopsy (EMB): early (≤ 2 days), delayed (> 2 days), or none.Results: The median age was 39 years (IQR 28–60), and 55% were female. Myocarditis was confirmed in 204 (69%) of the patients via histology or cardiac MRI. Histological data were available for 151 (51%) of the cohort. One-year mortality was 36%, while 44% died or had an HTx or LVAD. Predictors of worse outcomes were giant cell myocarditis, older age, cardiac arrest at ECMO initiation, and delayed EMB. Delayed EMB was consistently associated with higher mortality, HTx, or LVAD compared to early (HR = 1.55; 95% CI 1.23–1.96; p < 0.01) or no EMB (HR = 1.59; 95% CI 1.26–2.01; p < 0.01). However, event-free survival did not differ significantly between early EMB and no EMB (HR = 1.03; 95% CI 0.80–1.32; p = 0.85).Conclusions: Despite a relatively young cohort, FM requiring t-MCS is associated with a high 1-year mortality rate. Timely recognition and early referral to specialized ECMO centers before cardiac arrest are critical.

AB - Background: Temporary mechanical circulatory support (t-MCS) is increasingly used in fulminant myocarditis (FM), yet long-term outcomes and risk factors remain poorly defined.Methods: From the FULLMOON international cohort (419 adults with suspected FM across 36 centers in 15 countries), 295 patients treated with venoarterial extracorporeal membrane oxygenation (V-A ECMO) and/or Impella were analyzed. The primary endpoint was mortality at 1 year, heart transplantation (HTx), or left-ventricular assist device (LVAD). Multivariate Cox regression identified predictors of adverse outcomes. A propensity score-weighted analysis assessed outcomes based on timing of endomyocardial biopsy (EMB): early (≤ 2 days), delayed (> 2 days), or none.Results: The median age was 39 years (IQR 28–60), and 55% were female. Myocarditis was confirmed in 204 (69%) of the patients via histology or cardiac MRI. Histological data were available for 151 (51%) of the cohort. One-year mortality was 36%, while 44% died or had an HTx or LVAD. Predictors of worse outcomes were giant cell myocarditis, older age, cardiac arrest at ECMO initiation, and delayed EMB. Delayed EMB was consistently associated with higher mortality, HTx, or LVAD compared to early (HR = 1.55; 95% CI 1.23–1.96; p < 0.01) or no EMB (HR = 1.59; 95% CI 1.26–2.01; p < 0.01). However, event-free survival did not differ significantly between early EMB and no EMB (HR = 1.03; 95% CI 0.80–1.32; p = 0.85).Conclusions: Despite a relatively young cohort, FM requiring t-MCS is associated with a high 1-year mortality rate. Timely recognition and early referral to specialized ECMO centers before cardiac arrest are critical.

KW - 2026 OA procedure

KW - Endomyocardial biopsy

KW - Fulminant myocarditis

KW - Outcomes

KW - Temporary mechanical support

KW - ECMO

UR - https://www.scopus.com/pages/publications/105027764570

U2 - 10.1007/s00134-025-08268-3

DO - 10.1007/s00134-025-08268-3

M3 - Article

C2 - 41524796

AN - SCOPUS:105027764570

SN - 0342-4642

VL - 52

SP - 240

EP - 251

JO - Intensive care medicine

JF - Intensive care medicine

ER -

Temporary mechanical support in fulminant myocarditis: Prognostic factors and clinical implications from the FULLMOON study

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