Background:Older adult burn patients experience disproportionately high morbidity and mortality due to age-related physiological decline and comorbidities. Understanding predictors of mortality is essential for risk stratification and improving outcomes. This meta-analysis evaluates mortality predictors and clinical outcomes among older adult burn patients, stratified into a younger cohort (60-79 y) and an older cohort (80+ y). Methods:A systematic search of PubMed, Scopus, and Web of Science was conducted on February 2, 2024. Meta-analyses were performed using R (version 4.4.1) with random-effects models. Relative risks (RRs) with 95% confidence intervals (CIs) were calculated. Risk of bias was assessed using the Newcastle-Ottawa Scale, and certainty of evidence was evaluated using GRADE. Results:Fifty-eight studies comprising 37,732 older adult burn patients were included. Patients aged 60-79 had significantly lower intensive care unit admission risk (RR: 0.75, 95% CI: 0.63-0.88) and lower mortality (RR: 0.65, 95% CI: 0.58-0.73) compared with those aged 80 or older. Total burn surface area (TBSA) strongly predicted mortality: TBSA 1%-9% versus 10%-19% (RR: 0.31, 95% CI: 0.21-0.44) and 10%-19% versus ≥20% (RR: 0.17, 95% CI: 0.11-0.27). Flame burns significantly increased mortality compared with scald burns (RR: 3.98, 95% CI: 2.68-5.91). Inhalation injury (RR: 2.95) and intubation (RR: 5.66) further elevated mortality risk. Grafting reduced mortality compared with conservative management (RR: 0.67, 95% CI: 0.54-0.82). Conclusions:Age 80 years or older, larger TBSA, flame burns, inhalation injury, and intubation substantially increase mortality in older adult burn patients, whereas grafting is associated with improved survival. These findings support age-specific risk stratification and tailored management strategies to optimize outcomes.

Occupational exposure to high-altitude environments, such as those experienced by pilots and astronauts, has been associated with unique challenges, including neurocognitive implications. White matter hyperintensities (WMH) detected through neuroimaging have emerged as potential markers of brain pathology in individuals with high-altitude careers. This meta-analysis aimed to explore the association between occupational high-altitude exposure and WMH burden. A systematic literature search was conducted following PRISMA guidelines in databases such as PubMed, Scopus, Web of Science, and Cochrane. Studies reporting WMH in pilots were included without language or date restrictions. Data extraction and quality assessment were performed independently by two reviewers. Pooled analyses were conducted using R software, and the risk of bias was assessed using the Newcastle-Ottawa scale. A total of 1,036 articles were screened, with five studies meeting the inclusion criteria. These studies included 441 individuals, comprising 264 pilots and 177 controls. Pilots exhibited a significantly higher mean number (MD: 3.57, 95

ABSTRACT:Despite the long history of experience in peripheral nerve reconstruction, dating back to the 1870s, recent decades have seen an explosion of innovation. Advancements have been made in primary repair, secondary repair, nerve grafts, tendon transfers, and, most recently, nerve transfers. These innovations address the distance-to-target problem faced by surgeons and provide improved functional outcomes. Key principles for successful nerve transfers include proper patient selection, preoperative discussions, intraoperative decisions, and postoperative management. In this review, we discuss 3 common peripheral nerve transfers: the anterior interosseous nerve to ulnar nerve transfer, median to radial nerve transfers, and the tibial to peroneal nerve transfer. These techniques can restore functional mobility in patients with severe peripheral nerve injuries.

BACKGROUND:Studies have shown mixed results regarding the association between irritable bowel syndrome (IBS) and metabolic syndrome (MS); This study aimed to assess the susceptibility of IBS patients to MS and its individual components. METHODS:PubMed, Scopus, Embase, and Web of Science were searched on 1/1/2023. Eligible studies were screened, and data on study characteristics, IBS diagnostic criteria, and metabolic syndrome components were extracted. Data were analysed in RevMan 5.4, with results reported as relative risk (RR) or mean difference (MD) and 95% confidence intervals. Statistical significance was set at p < 0.05. RESULTS:IBS was associated with an increased risk of MS (RR = 2.05, 95% CI = 1.50-2.79, p < 0.00001), with a higher risk among IBS-D patients (RR = 3.09, 95% CI = 2.41-3.97, p < 0.00001). IBS patients showed increased HOMA-IR (MD = 0.21, 95% CI = 0.15-0.26, p < 0.00001), higher obesity risk (RR = 1.46, 95% CI = 1.10-1.93, p = 0.009), elevated BMI (MD = 1.51, 95% CI = 0.98-2.03, p-value < 0.00001), waist circumference (MD = 5.01, 95% CI = 1.29-8.72, p = 0.008), and an association with systolic hypertension (MD = -0.50, 95% CI = -0.60 to -0.40, p-value < 0.00001). IBS was also linked to higher LDL (MD = 5.98, 95% CI = 0.91-11.05, p = 0.02), total cholesterol (MD = 12.21, 95% CI = 6.23-18.18, p < 0.0001), and triglycerides (MD = 11.93, 95% CI = 11.55-12.31, p < 0.00001). CONCLUSIONS:This analysis indicates a potential association between IBS and metabolic syndrome, including its components such as obesity, hypertension, and lipid profile abnormalities. However, significant heterogeneity among studies limits the generalisability of these findings. Clinicians should remain aware of the possible link and consider individualised preventive and management strategies.

Background Menstrual irregularities are associated with various health risks, but their connection to cardiovascular disease (CVD) remains unclear. This meta-analysis aims to evaluate the link between irregular menstruation and cardiovascular and metabolic outcomes in women. Methods A systematic search of online databases was conducted for studies comparing cardiovascular and metabolic outcomes between women with irregular and regular menstrual cycles. Pooled risk ratios (RR) and 95% confidence intervals (CI) were calculated adopting a random effects model. Results Eight observational studies involving 354,419 women were analyzed. Women with irregular menstrual cycles had a significantly higher risk of developing cardiovascular disease overall (RR: 1.43, 95% CI: 1.01–2.03) compared to those with regular cycles. Subgroup analyses showed an increased risk of coronary artery disease (RR: 1.29, 95% CI: 1.14–1.46), hypertension (RR: 1.50, 95% CI: 1.23–1.82), and heart failure (RR: 1.45, 95% CI: 1.11–1.89) among women with irregular cycles. Cerebrovascular disease risk was elevated in this group (RR: 1.62, 95% CI: 1.10–2.40). Furthermore, women with irregular cycles demonstrated a greater likelihood of developing diabetes mellitus (RR: 1.75, 95% CI: 1.31–2.34) and hypercholesterolemia (RR: 1.33, 95% CI: 1.16–1.52). Conclusion Menstrual irregularities are linked to an increased risk of various cardiovascular, cerebrovascular, and metabolic conditions. This underscores the need for regular medical check-ups to aid in early detection and prevention of these diseases.

BACKGROUND:Menstrual cycle irregularities have been linked to several health hazards; it is unclear how these risks relate to cardiovascular disease (CVD). The purpose of this meta-analysis was to compile data regarding the relationship between irregular menstruation and women's cardiovascular and metabolic outcomes. METHODS:A systematic search of online databases was conducted for studies comparing cardiovascular and metabolic outcomes between women with irregular and regular menstrual cycles. Pooled risk ratios (RR) and 95 % confidence intervals (CI) were calculated adopting a random effects model. RESULTS:Eight observational studies comprising 354,419 women were included. Women with irregular menstrual cycles showed a significantly increased risk of overall cardiovascular disease (RR: 1.43, 95 % CI: 1.01 to 2.03) compared to those with regular menstrual cycles. Subgroup analyses for specific cardiovascular outcomes demonstrated increased risks of coronary artery disease (RR: 1.29, 95 % CI: 1.14-1.46), hypertension (RR: 1.50, 95 % CI: 1.23-1.82) and heart failure (RR: 1.45, 95 % CI: 1.11-1.89) in women with irregular cycles compared to those with regular cycles. Additionally, the risk of cerebrovascular disease was higher in women with irregular cycles compared to those with regular cycles (RR: 1.62, 95 % CI: 1.10-2.40), Notably, patients with irregular menstrual cycles were found to have a higher risk of developing diabetes mellitus (RR: 1.75, 95 % CI: 1.31-2.34) and hypercholesterolemia (RR: 1.33, 95 % CI: 1.16-1.52). CONCLUSION:Menstrual irregularities are associated with greater risks for several cardiovascular, cerebrovascular and metabolic diseases. Thus, highlighting the importance of regular check-ups to prevent disease occurrence in these patients.

Introduction: Reduction mammoplasty alleviates physical and psychological discomfort in patients with large breasts. The present study sought to determine preoperative markers that may herald postoperative complications. Methods: The NSQIP 2021 data file was queried using CPT and ICD-10 diagnosis codes to identify patients who underwent reduction mammoplasty at participating hospitals. To reduce confounders, patients undergoing gender affirming surgeries and males were excluded from the analysis. Preoperative comorbidities and laboratory values were analyzed using univariate and multivariate regression to determine their association with overall 30-day postoperative complications. Results: In total, 5909 reduction mammoplasty patients were identified. Patients aged ≥ 65 years had 1.47 times higher odds of developing complications after breast reduction compared to those who were younger in age (95% CI 1.02 - 2.07, P < 0.05). Tobacco use had 1.65 times higher chance of developing complications after their surgery compared to no tobacco use (95% CI 1.11-2.38, P < 0.05) and similarly, patients with ASA class III-V had 1.6 times higher odds of complications after their surgery compared to ASA class I-II (1.25-2.03, P < 0.05). Conclusion: Patients aged ≥ 65 years, those who smoke tobacco, have obesity (BMI ≥ 30), and/or are classified as ASA III-V are significantly associated with increased 30-day complication rates following reduction mammoplasty. Preoperative counseling of these patients should emphasize the importance of modifying risk factors-such as smoking cessation and weight reduction-and clearly communicate their high risk of postoperative complications to support informed decision-making and foster realistic patients expectations.

Background Cannabis use is increasingly prevalent worldwide, yet its impact on perioperative outcomes remains poorly understood. This study aims to comprehensively evaluate the association between cannabis use and perioperative complications through a systematic review and meta- analysis with a specific focus on propensity score-matched (PSM) studies. Methods We conducted a systematic search of PubMed, Scopus, and Web of Science from inception to January 30th, 2024. Studies comparing perioperative outcomes between participants who use cannabis and non-users were included. Random-effects meta-analysis was performed using R version 4.3.2 to calculate risk ratios (RR) and 95% confidence intervals (CI). Results Eight studies comprising 71,676 participants, of whom cannabis use was associated with increased risks of myocardial infarction (RR=1.47, 95% CI 1.12-1.93), neurological complications (RR=1.54, 95% CI 1.25-1.89), renal complications (RR=1.47, 95% CI 1.12-1.93), and a slightly longer length of hospital stay (MD=0.53, 95% CI 0.18-0.88). No significant differences were found for thromboembolic events, sepsis, respiratory complications, or in-hospital mortality in PSM analyses. Conclusion This meta-analysis reveals that cannabis use is associated with increased risks of specific perioperative complications, particularly cardiovascular, neurological, and renal events.In addition, it is associated with a slightly longer hospital stay. These findings underscore the importance of preoperative cannabis screening and tailored perioperative management for people who use cannabis.

Background: Loss of breast sensation following mastectomy and reconstruction significantly impacts quality of life, influencing body image, intimacy, and overall emotional well-being. Despite advances in reconstructive techniques, sensory outcomes remain inconsistent, limiting broader clinical adoption of reinnervation strategies. This educational review synthesizes the current scope of sensory restoration in breast reconstruction, examining approaches to reinnervation, sensory outcome measures, and management of patient expectations. Methods: The existing literature on breast reconstruction was reviewed along with evidence on nerve repair more generally to evaluate current microsurgical techniques and identify research gaps. Data extracted included quantitative outcomes, such as Semmes-Weinstein monofilament testing and 2-point discrimination, as well as qualitative or patient-reported outcome measures like BREAST-Q or VMP-B scores. Statistical analyses were performed using R software version 4.4.1. Results: Innervated deep inferior epigastric perforator (DIEP) flaps and targeted nerve grafting serve as promising techniques, achieving improved tactile recovery in both objective and qualitative measures. However, variability in long-term recovery, the diminishing returns of meaningful recovery in longer nerve grafts (R-2 = 0.986), and their impact on quality-of-life metrics remain underexplored. Moreover, the inconsistent sensory outcomes heighten the need for psychosocial support to manage patient expectations. Conclusions: Longitudinal studies emphasizing innovative grafting strategies and integration of emerging technologies including bioengineered nerve conduits and regenerative therapies offer exciting opportunities to enhance sensory recovery. Advancing sensory restoration in reconstructive breast surgery requires a patient-centered approach to inform surgical practice by aligning clinical enthusiasm with robust evidence, ensuring meaningful and rigorous improvements in functional and emotional outcomes.

Introduction: Reduction mammoplasty alleviates physical and psychological discomfort in patients with large breasts. The present study sought to determine preoperative markers that may herald postoperative complications. Methods: The NSQIP 2021 data file was queried using CPT and ICD-10 diagnosis codes to identify patients who underwent reduction mammoplasty at participating hospitals. To reduce confounders, patients undergoing gender affirming surgeries and males were excluded from the analysis. Preoperative comorbidities and laboratory values were analyzed using univariate and multivariate regression to determine their association with overall 30-day postoperative complications. Results: In total, 5909 reduction mammoplasty patients were identified. Patients aged >= 65 years had 1.47 times higher odds of developing complications after breast reduction compared to those who were younger in age (95% CI 1.02 - 2.07, P < 0.05). Tobacco use had 1.65 times higher chance of developing complications after their surgery compared to no tobacco use (95% CI 1.11-2.38, P < 0.05) and similarly, patients with ASA class III-V had 1.6 times higher odds of complications after their surgery compared to ASA class I-II (1.25-2.03, P < 0.05). Conclusion: Patients aged >= 65 years, those who smoke tobacco, have obesity (BMI >= 30), and/or are classified as ASA III-V are significantly associated with increased 30-day complication rates following reduction mammoplasty. Preoperative counseling of these patients should emphasize the importance of modifying risk factors-such as smoking cessation and weight reduction-and clearly communicate their high risk of postoperative complications to support informed decision-making and foster realistic patients expectations.

ABSTRACT:International medical graduates (IMGs) represent a significant portion of the US physician workforce, comprising 25% across all specialties with a strong presence in internal medicine and primary care. However, their representation in plastic surgery remains limited at only 10%. Matching into a US plastic surgery residency is highly competitive for both US medical graduates and IMGs. This study aimed to quantify and identify trends in academic contributions from IMGs applicants in a plastic surgery residency program over the past 13 years, hypothesizing that IMG applicants have increasingly contributed to collaborative research projects.Data from National Resident Matching Program annual reports were analyzed, focusing on publications, research experience, and match status. An analysis of variance revealed significant differences between US MDs and IMGs in terms of publications and research experience. IMGs had a higher number of publications and work experience compared to matched US MDs, while US MDs had more research experiences than IMGs.The findings underscore the importance of research for IMGs, who often engage in additional research experiences to enhance their competitiveness for residency positions. The study showed that IMGs have a greater research output, contributing significantly to academic publications within the plastic surgery field. This productivity benefits the IMGs in securing residency positions and enriches the academic research environment of the residency programs.IMGs bring unique perspectives and innovative approaches to research, often collaborating internationally, which enhances the scope and quality of research projects. Their contributions are vital to the advancement of plastic surgery and the broader medical field. As the demand for physicians in the US grows, integrating IMGs into the healthcare system through strategic inclusion in research and clinical training is essential. This study highlights the critical role of IMGs in driving medical research and underscores the need for supportive policies to facilitate their integration into the US healthcare workforce.

Prosthetic rehabilitation after amputation poses significant challenges, often due to functional limitations, residual limb pain (RLP), and phantom limb pain (PLP). These issues not only affect physical health but also mental well-being and quality of life. In this review, we describe targeted muscle reinnervation (TMR) and regenerative peripheral nerve interface (RPNI) and explore their clinical role in the evolution of myoelectric prosthetic control as well as postamputation pain and neuroma management. Early myoelectric prostheses, which detected electrical potentials from muscles to control prosthetic limbs, faced limitations such as inconsistent signal acquisition and complex control modes. Novel microsurgical techniques at the turn of the century such as TMR and RPNI significantly advanced myoelectric prosthetic control. TMR involves reinnervating denervated muscles with residual nerves to create electromyography (EMG) potentials and prevent painful neuromas. Similarly, RPNI relies on small muscle grafts to amplify EMG signals and distinguish from stochastic noise for refined prosthetic control. Techniques like TMR and RPNI not only improved prosthetic function, but also significantly reduced postamputation pain, making them critical in improving amputees' quality of life. Modern myoelectric prostheses evolved with advancements in microprocessor and sensor technologies, enhancing their functionality and user experience. Today, researchers have developed more intuitive and reliable prosthetic control by utilizing pattern recognition software and machine learning algorithms that may supersede reliance on surgically amplifying EMG signals. Future developments in brain-computer interfaces and machine learning hold promise for even greater advancements in prosthetic technology, emphasizing the importance of continued innovation in this field.

Background Studies have discussed the efficacy of bariatric surgery (BS) in remission of individual components of metabolic syndrome (MS). We aimed to analyse the prevalence of MS following BS. Methods On October 5, 2023, we conducted a literature search on PubMed, Scopus, Web of Science, and Cochrane. RevManv5.4 was used for the analysis. Results MS patients who underwent BS had lower odds of MS within the first year post-BS (OR 0.14, 95%CI 0.12-0.17); patients who had a preoperative BMI < 50 showed a higher reduction in MS post-BS compared with patients who suffered from super obesity (OR 0.12 versus OR 0.17). Older patients (age > 42) had lower odds of MS post-BS compared with younger patients (OR 0.05 versus OR 0.17). There was not a difference in MS prevalence between 1 and 2 years postoperatively (OR 1.07, 95%CI 0.72-1.58). Asians reported the highest reduction in MS post-BS (OR 0.08). MS patients who received medical treatment had three times the odds of having MS compared with patients who underwent BS. Patients who had BS reported a decline in their anti-hypertensives and oral anti-diabetic drugs (OR 0.26, 95%CI 0.15-0.46, OR 0.11, 95%CI 0.07-0.16, respectively). There was not a significant difference in MS prevalence between patients who underwent RYGB and those who had SG (OR 2.16, 95%CI 0.74-6.26). Conclusions BS is superior to medical treatment in the remission of MS. Age, preoperative BMI, and country of origin affect the rates of MS remission. BS results in a sustainable resolution of MS across 1, 2, and 5 years post-surgery. A tailored approach is warranted to achieve the best outcomes.

Despite the long history of experience in peripheral nerve reconstruction, dating back to the 1870s, recent decades have seen an explosion of innovation. Advancements have been made in primary repair, secondary repair, nerve grafts, tendon transfers, and, most recently, nerve transfers. These innovations address the distance-to-target problem faced by surgeons and provide improved functional outcomes. Key principles for successful nerve transfers include proper patient selection, preoperative discussions, intraoperative decisions, and postoperative management. In this review, we discuss 3 common peripheral nerve transfers: the anterior interosseous nerve to ulnar nerve transfer, median to radial nerve transfers, and the tibial to peroneal nerve transfer. These techniques can restore functional mobility in patients with severe peripheral nerve injuries.

Abstract Purpose The treatment of critical limb-threatening ischemia (CLTI) is revascularization. Lumbar sympathectomy (LS) could be attempted when this is not amenable. Using laparoscopic techniques to perform LS adds the advantages of minimally invasive surgery. Methods Twenty-four patients, presenting with non-reconstructable CLTI and rest pain, were randomly divided into group I (14 patients) who underwent retroperitoneoscopic lumbar sympathectomy (RPLS) and group II (10 patients) who had conventional open lumber sympathectomy (COLS). Results RPLS patients had shorter hospital stays, fewer intraoperative complications, and less postoperative pain. However, the mean operative time was significantly longer (86.4 ± 9.1 min, p-value: 0.02) in the RPLS group but decreased with each subsequent case after that. The differences in post-operative capillary refill time, ABI, TBI, and TcPO2 were not statistically significant between both groups (p-values: 0.97, 0.13, 0.32, 0.10, respectively). However, the difference in the quality-of-life score was statistically significant; the mean (± SD) SF-36 score increased from 48 ± 6.8 to 81 ± 4.4 (p-value < 0.001) in RPLS group compared to 52 ± 8.8 to 59 ± 1.2 (p-value: 0.52) in COLS group. Conclusion RPLS is feasible, safe, and has the advantages of minimally invasive surgery: minimal blood loss, less intraoperative complications, shorter hospital stay, and less postoperative pain. However, the operative time in RPLS cases is longer than in the COLS; training on the procedure is recommended to improve the learning curve.

Background Early oral feeding has been previously postulated to contribute to developing postoperative complications following head and neck reconstructive surgeries using free flaps. This study assessed the association between the timing of oral feeding (early vs. late) and postoperative complications and length of hospital stay among these patients.Method PubMed, Scopus, Cochrane, and Web of Science were searched using terms such as "oral feeding" and "head or neck cancer." We utilized RevMan software version 5.4 for the analysis. The study defined early oral feeding as feeding within 5-day post-operation, while late oral feeding was defined as feeding after the fifth postoperative day. Five papers that met the inclusion criteria were included in the analysis, with 1097 patients.Results The results showed that early feeding was not significantly associated with postoperative fistulas (RR 0.49, 95% CI 0.23 to 1.05, p-value = 0.07), hematoma/seroma (RR 0.71, 95% CI 0.33 to 1.51, p-value = 0.38), or flap failure (RR 0.84, 95% CI = 0.38 to 1.87, p-value = 0.67). However, early oral feeding was significantly associated with shorter hospital stays than late oral feeding (MD -3.18, 95% CI -4.90 to -1.46, p-value = 0.0003).Conclusion No significant difference exists between early and late oral feeding regarding the risk of postoperative complications in head and neck cancer (HNC) patients who underwent free flap reconstruction surgery. However, early oral feeding is significantly associated with a shorter hospital stay than late oral feeding. Thus, surgeons should consider implementing early oral feeding after free flap reconstruction in HNC patients.

Purpose:Postoperative blood loss is a common complication following total knee arthroplasty (TKA). The authors aimed to analyze the significance of open versus closed-box prostheses in reducing blood loss after TKA. Methods:PubMed, Cochrane, Scopus, and Web of Science were searched. Observational studies and clinical trials comparing the effect of open-box versus closed-box prostheses on blood loss following TKA were included. The primary outcome was total blood loss following TKA. Secondary outcomes included average transfused units and total operation time. Continuous data were represented as mean difference (MD) and CI, while dichotomous data were presented as odds ratio (OR) and CI. RevMan software version 5.4 was used to conduct the analysis. Results:Four studies with a total number of 687 patients were included. The pooled analysis showed a statistically significant association between closed-box and decreased total blood loss following TKA compared with open-box (MD=173.19, 95% CI=88.77-257.61, P value <0.0001). Similar findings were reported in unilateral TKA (MD=190.63, 95% CI=70.91-310.35, P value=0.002), and bilateral TKA (MD=160.79, 95% CI=61.70-359.86, P value=0.001). There was no significant difference between open and closed-box regarding average transfused units (MD=0.02, 95% CI=-0.07-0.11, P value=0.68), blood transfusion rate (OR=1.38, 95% CI=0.85-2.26, P value=0.20), length of stay (MD=0.06, 95% CI=-0.27 to 0.38, P value=0.74), and total operation time (MD=1.08, 95% CI=-4.62 to 6.79, P value=0.71). Conclusion:Closed-box reduces the total blood loss following unilateral and bilateral TKA. More studies are warranted to explore the benefits of Closed-box in patients with high bleeding susceptibility.

Background:Fulminant myocarditis (FM) is a potentially life-threatening disease that requires emergency care. The authors' study aims to explore clinical outcomes and predictors of survival when using veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support for the treatment of FM in adult and pediatric patients to analyze differences between both populations. Methods:PubMed, Scopus, Web of Science, and Cochrane databases were searched for studies reporting the effect of VA-ECMO on patients diagnosed with fulminant myocarditis. Statistical analysis was performed using R version 4.2.2. Results:Forty-three studies were included in our analysis with a total of 1268 patients. Survival rates were 65% and 71% among adult and pediatric patients, respectively. Patients who didn't suffer from cardiac arrest prior to VA-ECMO had better chances of survival in both populations; adults (OR 0.44; P<0.01) and pediatric (OR = 0.32; P= 0.006). Younger age was associated with higher survival among the adults (MD= -8.81; P<0.01). Additionally, pre-ECMO LVEF was higher among survivors in the pediatric group (MD= 8.23; P<0.01). Furthermore, no significant association was detected between sex, VA-ECMO duration, systolic blood pressure, lactate levels, and survival rates among both groups. Conclusion:Using VA-ECMO in patients with fulminant myocarditis can significantly improve survival outcomes, with improved prognosis observed with younger age among adults and absence of prior history of cardiac arrest in both groups.