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Published on: October 24, 2018
Extracorporeal Membrane Oxygenation in Children With COVID-19: A Systematic Review and Meta-Analysis
Atsuyuki Watanabe1, Jun Yasuhara2,3, Takaharu Karube4
1Division of Hospital Medicine, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan.
Insights
Extracorporeal membrane oxygenation (ECMO) for pediatric COVID-19 patients showed a 26.6% mortality rate. This treatment is a viable option for critically ill children, with therapies like corticosteroids improving outcomes.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Cardiopulmonary support
Background:
- Extracorporeal membrane oxygenation (ECMO) indications, complications, and outcomes in pediatric COVID-19 cases were not well-defined.
- This study aimed to elucidate ECMO's role in treating children with COVID-19-related illnesses.
Approach:
- A systematic literature search was conducted on PubMed and EMBASE databases.
- Data from 110 children (≤18 years) with COVID-19 receiving ECMO were extracted and analyzed using meta-analysis.
Key Points:
- The most common indications for ECMO were multisystem inflammatory syndrome in children (52%) and severe acute respiratory distress syndrome (40%).
- Overall mortality was 26.6%, with a successful weaning rate of 77.0%.
- Complications included stroke, acute kidney injury, and thromboembolism; corticosteroids and IV immunoglobulin were associated with lower mortality.
Conclusions:
- ECMO is a potentially life-saving treatment for critically ill children with COVID-19.
- The observed mortality rate suggests ECMO can be a beneficial intervention in this patient population.
Objectives:
The indication, complications, and outcomes of extracorporeal membrane oxygenation (ECMO) in children with COVID-19-related illnesses remain unelucidated. Our study aimed to investigate the characteristics and outcomes of ECMO in children with COVID-19-related illnesses.
Data Sources:
We searched PubMed and EMBASE databases in March 2022.
Study Selection:
We retrieved all studies involving children (age ≤ 18 yr) with COVID-19-related illnesses who received ECMO.
Data Extraction:
Two authors independently extracted data and assessed the risk of bias. Mortality, successful weaning rate, and complications while on ECMO were synthesized by a one-group meta-analysis using a random-effect model. Meta-regression was performed to explore the risk factors for mortality.
Data Synthesis:
We included 18 observational studies, four case series, and 22 case reports involving 110 children with COVID-19-related illnesses receiving ECMO. The median age was 8 years (range, 10 d to 18 yr), and the median body mass index was 21.4 kg/m 2 (range, 12.3-56.0 kg/m 2 ). The most common comorbidities were obesity (11% [7/63]) and congenital heart disease (11% [7/63]), whereas 48% (30/63) were previously healthy. The most common indications for ECMO were multisystem inflammatory syndrome in children (52% [47/90]) and severe acute respiratory distress syndrome (40% [36/90]). Seventy-one percent (56/79) received venoarterial-ECMO. The median ECMO runtime was 6 days (range, 3-51 d) for venoarterial ECMO and 11 days (range, 3-71 d) for venovenous ECMO. The mortality was 26.6% (95% CI, 15.9-40.9), and the successful weaning rate was 77.0% (95% CI, 55.4-90.1). Complications were seen in 37.0% (95% CI, 23.1-53.5) while on ECMO, including stroke, acute kidney injury, pulmonary edema, and thromboembolism. Corticosteroids and IV immunoglobulin therapies were associated with lower mortality.
Conclusions:
The mortality of children on ECMO for COVID-19 was relatively low. This invasive treatment can be considered as a treatment option for critically ill children with COVID-19.
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