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ECMO support in SARS-CoV2 multisystem inflammatory syndrome in children in a child
Shubhi Kaushik1, Neha Ahluwalia2, Sandeep Gangadharan1
1Department of Pediatrics, Division of Critical Care Medicine, Kravis Children's Hospital at Mount Sinai, New York, USA.
Insights
This report details a rare case of a 5-year-old boy with severe COVID-19-related MIS-C, requiring ECMO. The case highlights the first pediatric stroke associated with SARS-CoV-2 infection.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Neurology
Background:
- Multi-system inflammatory syndrome in children (MIS-C) associated with SARS-CoV-2 infection can lead to severe illness.
- Early diagnosis of MIS-C can be challenging, especially with negative initial viral tests.
- Neurological complications, including stroke, are increasingly recognized in pediatric COVID-19 cases.
Observation:
- A 5-year-old previously healthy male presented with respiratory failure and vasoplegic shock due to MIS-C.
- Initial SARS-CoV-2 reverse transcription-polymerase chain reaction (RT-PCR) testing was negative, but antibody testing was positive.
- The patient required mechanical ventilation, vasopressors, and extracorporeal membrane oxygenation (ECMO) for refractory shock and respiratory failure.
Findings:
- Echocardiogram showed mildly depressed left ventricular function without coronary anomalies.
- The patient developed a middle cerebral artery infarct and left frontal subarachnoid hemorrhage.
- This represents the youngest reported case of MIS-C requiring ECMO and the first pediatric stroke linked to SARS-CoV-2.
Implications:
- This case underscores the potential for severe, multi-systemic complications of SARS-CoV-2 in children, including neurological events.
- It emphasizes the importance of considering MIS-C in children with severe illness, even with negative initial viral tests.
- The findings highlight the need for further research into the pathophysiology and management of SARS-CoV-2-related neurological complications in pediatric populations.
Abstract:
In this report, we describe the case of a 5-year-old male with SARS-CoV-2 associated MIS-C with progressive respiratory failure and vasoplegic shock requiring extracorporeal support. At presentation, reverse transcription-polymerase chain reaction (RT-PCR) testing for SARS-CoV-2 was negative, however, SARS-CoV2 antibody testing was positive. Multiple inflammatory markers and cardiac biomarkers were elevated. Echocardiogram demonstrated mildly depressed left ventricular function and no coronary anomalies noted. The patient required mechanical ventilation, vasopressors, and eventually extracorporeal membrane oxygenation (ECMO) for profound circulatory shock and progressive respiratory failure. During his clinical course, recovery of cardiac function was demonstrated however, a middle cerebral artery infarct and left frontal subarachnoid hemorrhage was suffered which ultimately the patient succumbed to. To the best of our knowledge, this is the youngest previously healthy child who had multi-system hyperinflammatory syndrome requiring ECMO support and the first case of SARS-CoV-2 related pediatric stroke.Clinical Trial Registration: None.
