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Extracorporeal membrane oxygenation (ECMO) is often used as a supportive therapy, but survival rates and the impact of adjunctive therapies like left ventricular (LV) unloading and bridge-to-heart transplantation remain unclear. This meta-analysis evaluates survival outcomes in pediatric AFM patients treated with ECMO and assesses the influence of these strategies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This systematic review and meta-analysis followed PRISMA guidelines. Databases, including PubMed, Embase, and the Cochrane Library, were searched for studies published in the last 10\u00a0years. Inclusion criteria were studies reporting survival rates of pediatric AFM patients treated with ECMO. Data were analyzed using fixed and random-effects models. Subgroup and univariable meta-regression analyses identified factors associated with survival.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      From 2308 articles, 10 studies met the inclusion criteria, totaling 210 pediatric patients. The pooled survival rate was 67% (95% CI: 37%-97%). Subgroup analyses showed higher survival in patients receiving LV unloading (82% vs 63%;\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; .01) and those bridged to heart transplantation, though not statistically significant. Univariable meta-regression identified LV unloading as a significant predictor of survival (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = .02). Other factors, such as age, gender, and cardiac arrest before ECMO, showed no significant associations with survival. Cumulative meta-analysis indicated an improving trend in survival over the years.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This meta-analysis suggests an association between ECMO and improved survival in children with AFM. While LV unloading may offer benefits, the retrospective nature of the included studies, along with potential confounding factors, necessitates cautious interpretation. Further well-designed prospective studies are required to establish its optimal role, indications, and timing in pediatric ECMO patients with AFM.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/02676591251334895","type":"journal-article","created":{"date-parts":[[2025,4,11]],"date-time":"2025-04-11T01:50:01Z","timestamp":1744336201000},"page":"1817-1830","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":4,"title":["Left ventricular unloading and survival outcomes in pediatric acute fulminant myocarditis patients receiving extracorporeal membrane oxygenation: A systematic review and meta-analysis"],"prefix":"10.1177","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2458-8529","authenticated-orcid":false,"given":"Hwa Jin","family":"Cho","sequence":"first","affiliation":[{"name":"Chonnam National University Children\u2019s Hospital and Medical School"},{"name":"Chonnam National University Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reverien","family":"Habimana","sequence":"additional","affiliation":[{"name":"Chonnam National University Hospital"},{"name":"Chonnam National University Graduate School"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Insu","family":"Choi","sequence":"additional","affiliation":[{"name":"Chonnam National University Children\u2019s Hospital and Medical School"},{"name":"Chonnam National University Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min-Keun","family":"Song","sequence":"additional","affiliation":[{"name":"Chonnam National University Medical School"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ji-Hyuk","family":"Yang","sequence":"additional","affiliation":[{"name":"Sungkyunkwan University School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoonseo","family":"Lee","sequence":"additional","affiliation":[{"name":"Sungkyunkwan University School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hoon","family":"Ko","sequence":"additional","affiliation":[{"name":"Pusan National University Yangsan Hospital"},{"name":"Pusan National University School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0051-8080","authenticated-orcid":false,"given":"Matteo","family":"Di Nardo","sequence":"additional","affiliation":[{"name":"IRCCS"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2249-0667","authenticated-orcid":false,"given":"In Seok","family":"Jeong","sequence":"additional","affiliation":[{"name":"Chonnam National University Hospital"},{"name":"Chonnam National University Hospital and Medical School"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,4,10]]},"reference":[{"issue":"4","key":"e_1_3_4_2_2","first-page":"279","article-title":"Fulminant myocarditis: characteristics, treatment, and outcomes","volume":"19","author":"Veronese G","year":"2018","unstructured":"Veronese G, Ammirati E, Cipriani M, et al. 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