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Operational Innovation in the Provision of Pediatric Extracorporeal Membrane Oxygenation for Multisystem Inflammatory
Catherine E Naber1, Neil D Fernandes1, Manuella Lahoud-Rahme1
1Catherine E. Naber, MD, and Neil D. Fernandes, MD, are Pediatric Critical Care Fellows, Division of Pediatric Critical Care Medicine; Manuella Lahoud-Rahme, MD, is a Pediatric Cardiologist, Division of Pediatric Critical Care and Division of Pediatric Cardiology; Phoebe H. Yager, MD, is a Pediatric Critical Care Physician and Chief, Division of Pediatric Critical Care Medicine; Brian M. Cummings, MD, is Medical Director and Vice Chair, Division of Pediatrics, and a Pediatric Critical Care Physician, Division of Pediatric Critical Care Medicine; Ryan W. Carroll, MD, MPH, is Director, Global Pediatric Critical Care Medicine, and a Pediatric Critical Care Physician, Division of Pediatric Critical Care Medicine; and Allan M. Goldstein, MD, is Surgeon-in-Chief; all at MassGeneral Hospital for Children. Danielle Doucette, RRT, is a Respiratory Therapist and ECMO Coordinator, Respiratory Care Services, and Allan M. Goldstein, MD, is Chief, Division of Pediatric Surgery, Department of Surgery; both at Massachusetts General Hospital. Allan M. Goldstein is the Marshall K. Bartlett Professor of Surgery, Department of Surgery; Brian M. Cummings, Phoebe H. Yager, and Ryan W. Carroll are Assistant Professors and Manuella Lahoud-Rahme is an Instructor, Department of Pediatrics; all at Harvard Medical School. All of the authors are located in Boston, MA.
Insights
Multisystem inflammatory syndrome in children (MIS-C) can strain critical care resources. Hospitals must prepare for simultaneous extracorporeal membrane oxygenation (ECMO) needs in pediatric MIS-C and adult COVID-19 patients.
Area of Science:
- Pediatrics
- Critical Care Medicine
- Infectious Diseases
Background:
- Multisystem inflammatory syndrome in children (MIS-C) presents a significant critical care challenge.
- Severe COVID-19 also necessitates extensive critical care resources, including extracorporeal membrane oxygenation (ECMO).
- Pediatric and adult patient populations may simultaneously require ECMO, straining institutional capacity.
Purpose of the Study:
- To alert mixed pediatric and adult hospitals to the potential for concurrent ECMO demand from MIS-C and COVID-19 patients.
- To highlight the critical care resource implications of managing these simultaneous demands.
Main Methods:
- Retrospective review of operations for pediatric patients with MIS-C requiring cardiogenic shock treatment.
- Analysis of ECMO utilization during a period of high adult COVID-19 admissions.
Main Results:
- During a 14-day period, 3 pediatric patients with MIS-C required critical care interventions.
- Two pediatric patients needed venoarterial ECMO (VA-ECMO); a third required transfer due to ECMO capacity limitations.
- Institutional ECMO resources were concurrently utilized by a large number of adult COVID-19 patients.
Conclusions:
- Pediatric referral centers within institutions serving adult ECMO patients face unique challenges during surges.
- Effective communication and collaborative planning between pediatric, adult, and regional ECMO teams are crucial.
- Proactive strategies are essential to ensure timely and safe ECMO provision for MIS-C patients amidst ongoing pandemic resource demands.
Abstract:
Treatment of multisystem inflammatory syndrome in children (MIS-C) can require significant critical care resources. Our aim is to alert mixed pediatric and adult hospitals worldwide of the possibility that pediatric and adult patients may simultaneously require cannulation to extracorporeal membrane oxygenation (ECMO) for MIS-C and severe COVID-19. We conducted a retrospective review of operations required to treat cardiogenic shock in 3 pediatric patients with a diagnosis of MIS-C admitted to a single medium-sized pediatric referral center located within a large academic medical center over a 14-day period. At this time, a large number of adult patients required ECMO for severe COVID-19 at our institution. Of the 11 pediatric patients who presented with MIS-C during the first surge of 2020, 2 patients required cannulation to venoarterial extracorporeal membrane oxygenation (VA-ECMO), and a third patient developed a life-threatening arrhythmia requiring transfer to a neighboring institution for consideration of VA-ECMO when our institution's ECMO capacity had briefly been reached. Pediatric referral centers located within institutions providing ECMO to adult patients with severe COVID-19 may benefit from frequent and direct communication with their adult and regional colleagues to devise a collaborative plan for safe and timely provision of ECMO to patients with MIS-C as the ongoing pandemic continues to consume this limited, lifesaving resource.
