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Extracorporeal Membrane Oxygenation Characteristics and Outcomes in Children and Adolescents With COVID-19 or
Melania M Bembea1, Laura L Loftis2, Ravi R Thiagarajan3
1Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
Insights
Extracorporeal membrane oxygenation (ECMO) use in pediatric COVID-19 and MIS-C was uncommon but varied significantly. Most pediatric patients requiring ECMO for these conditions survived, similar to pre-pandemic outcomes.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Cardiopulmonary support
Background:
- Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can cause critical illness in children, including multisystem inflammatory syndrome in children (MIS-C).
- Extracorporeal membrane oxygenation (ECMO) is a life-support measure for severe cardiac or respiratory failure.
- Data on pediatric ECMO use for SARS-CoV-2-related conditions are limited.
Purpose of the Study:
- To describe the characteristics and outcomes of pediatric patients (<21 years) requiring ECMO for acute COVID-19 or MIS-C.
- To compare ECMO utilization and patient profiles between MIS-C and acute COVID-19.
- To evaluate in-hospital mortality and morbidity in pediatric ECMO patients.
Main Methods:
- Retrospective case series using the Overcoming COVID-19 public health surveillance registry.
- Inclusion of patients <21 years admitted to the ICU with MIS-C or acute COVID-19.
- Analysis of demographic, clinical, ECMO parameters, and outcomes data from 63 hospitals (March 2020–December 2021).
Main Results:
- A total of 2,733 patients were analyzed; 3.7% (n=108) required ECMO (37 MIS-C, 71 COVID-19).
- ECMO patients were older and had higher BMIs (COVID-19 group).
- MIS-C patients received venoarterial ECMO more frequently for cardiac indications, with shorter ECMO/hospital stays and lower mortality (27% vs. 37%) compared to COVID-19 patients.
Conclusions:
- ECMO support for pediatric SARS-CoV-2 infections is infrequent but shows distinct patterns in MIS-C versus acute COVID-19.
- Differences in ECMO type, indication, and duration were observed between the two conditions.
- Survival to discharge was high, aligning with pre-pandemic pediatric ECMO outcomes.
Objectives:
Extracorporeal membrane oxygenation (ECMO) has been used successfully to support adults with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related cardiac or respiratory failure refractory to conventional therapies. Comprehensive reports of children and adolescents with SARS-CoV-2-related ECMO support for conditions, including multisystem inflammatory syndrome in children (MIS-C) and acute COVID-19, are needed.
Design:
Case series of patients from the Overcoming COVID-19 public health surveillance registry.
Setting:
Sixty-three hospitals in 32 U.S. states reporting to the registry between March 15, 2020, and December 31, 2021.
Patients:
Patients less than 21 years admitted to the ICU meeting Centers for Disease Control criteria for MIS-C or acute COVID-19.
Interventions:
None.
Measurements And Main Results:
The final cohort included 2,733 patients with MIS-C ( n = 1,530; 37 [2.4%] requiring ECMO) or acute COVID-19 ( n = 1,203; 71 [5.9%] requiring ECMO). ECMO patients in both groups were older than those without ECMO support (MIS-C median 15.4 vs 9.9 yr; acute COVID-19 median 15.3 vs 13.6 yr). The body mass index percentile was similar in the MIS-C ECMO versus no ECMO groups (89.9 vs 85.8; p = 0.22) but higher in the COVID-19 ECMO versus no ECMO groups (98.3 vs 96.5; p = 0.03). Patients on ECMO with MIS-C versus COVID-19 were supported more often with venoarterial ECMO (92% vs 41%) for primary cardiac indications (87% vs 23%), had ECMO initiated earlier (median 1 vs 5 d from hospitalization), shorter ECMO courses (median 3.9 vs 14 d), shorter hospital length of stay (median 20 vs 52 d), lower in-hospital mortality (27% vs 37%), and less major morbidity at discharge in survivors (new tracheostomy, oxygen or mechanical ventilation need or neurologic deficit; 0% vs 11%, 0% vs 20%, and 8% vs 15%, respectively). Most patients with MIS-C requiring ECMO support (87%) were admitted during the pre-Delta (variant B.1.617.2) period, while most patients with acute COVID-19 requiring ECMO support (70%) were admitted during the Delta variant period.
Conclusions:
ECMO support for SARS-CoV-2-related critical illness was uncommon, but type, initiation, and duration of ECMO use in MIS-C and acute COVID-19 were markedly different. Like pre-pandemic pediatric ECMO cohorts, most patients survived to hospital discharge.
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