OBJECTIVES: To explore early warning indicators for extracorporeal membrane oxygenation (ECMO) in children with fulminant myocarditis (FM) and their association with prognosis. METHODS: Clinical data of 22 children with FM admitted to the Pediatric Intensive Care Unit of Hainan Women and Children's Medical Center from June 2019 to June 2025 were retrospectively analyzed. Patients were grouped by ECMO support (ECMO group, n=10; non-ECMO group, n=12) and by outcome (survival group, n=17; death group, n=5). Data on demographics, laboratory values, echocardiographic measurements, and treatments administered were collected. The predictive value of early warning indicators for initiating ECMO was assessed by receiver operating characteristic (ROC) curve analysis. RESULTS: Compared with the non-ECMO group, the ECMO group had lower left ventricular ejection fraction (LVEF) and fractional shortening (FS), and higher peak brain natriuretic peptide (BNP), peak vasoactive-inotropic score (VIS), peak lactate, and a higher proportion of interventricular septal and ventricular wall hypokinesis (all P<0.05). ROC analysis showed that peak BNP >21 650 pg/mL predicted the need for ECMO with a sensitivity of 80%, specificity of 82%, positive predictive value of 80%, negative predictive value of 60%, and an area under the curve of 0.771 (P<0.05). The overall mortality was 23% (5/22). Compared with survivors, non-survivors had lower Pediatric Critical Illness Score (PCIS), LVEF, and FS, and higher peak VIS, peak lactate, lactate level at 24 hours after treatment, and a higher rate of ECMO use (all P<0.05). CONCLUSIONS: Peak BNP >21 650 pg/mL has early warning value for determining the need for ECMO support in children with FM. PCIS, LVEF, FS, VIS, and lactate are useful for assessing disease severity and prognosis. ECMO is a critical life-support modality for extremely severe FM. 目的: 探讨儿童暴发性心肌炎（fulminant myocarditis, FM）接受体外膜肺氧合（extracorporeal membrane oxygenation, ECMO）辅助治疗的早期预警指标及其与预后的关系。方法: 回顾性分析2019年6月—2025年6月于海南省妇女儿童医学中心儿童重症监护病房收治的22例FM患儿的临床资料。根据是否接受ECMO辅助治疗分为ECMO组（10例）与非ECMO组（12例）;根据预后分为存活组（17例）与死亡组（5例）。收集患儿的一般资料、实验室指标、心脏超声参数及治疗干预情况，采用受试者操作特征曲线分析FM患儿需启动ECMO辅助治疗的早期预警指标的预测价值。结果: 与非ECMO组相比，ECMO组患儿左室射血分数（left ventricular ejection fraction, LVEF）和短轴收缩率（fractional shortening, FS）更低，脑钠肽（brain natriuretic peptide, BNP）峰值、血管活性药物评分（Vasoactive⁃Inotropic Score, VIS）峰值、乳酸峰值、室间隔及室壁运动减低比例更高（P<0.05）。受试者操作特征曲线分析显示，BNP峰值>21 650 pg/mL可作为预测FM患儿需ECMO辅助治疗的指标，灵敏度为80%，特异度为82%，阳性预测值为80%，阴性预测值为60%，曲线下面积为0.771（P<0.05）。FM患儿的总病死率为23%（5/22）。与存活组相比，死亡组患儿儿童危重病例评分、LVEF、FS更低，VIS峰值、乳酸峰值、治疗24 h后乳酸水平及ECMO使用率更高（P<0.05）。结论: BNP峰值>21 650 pg/mL对预测FM患儿需ECMO辅助治疗具有早期预警价值。儿童危重病例评分、LVEF、FS、VIS及乳酸等指标可用于评估FM患儿的病情严重程度及预后。ECMO是救治极危重FM患儿的关键生命支持手段。.