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Pediatric COVID-19 extracorporeal membrane oxygenation transport during the pandemic
Marco Daverio1,2, Sylvia Belda Hofheinz3,4,5, Vladimiro Vida2,6
1Pediatric Intensive Care Unit, University Hospital of Padova, Padova, Italy.
Insights
Pediatric COVID-19 patients requiring Extracorporeal Membrane Oxygenation (ECMO) transport showed a 60% survival rate. These complex transports were feasible and safe for patients and ECMO teams, with no reported COVID-19 transmission to staff.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Cardiopulmonary support
Background:
- Extracorporeal Membrane Oxygenation (ECMO) is a life-saving intervention for critically ill pediatric patients.
- COVID-19 presents unique challenges for pediatric ECMO, including transmissibility risks and PPE requirements for transport teams.
- Limited data exists on the outcomes of pediatric COVID-19 patients undergoing ECMO transport.
Purpose of the Study:
- To explore the outcomes of pediatric COVID-19 patients undergoing ECMO transport.
- To assess the feasibility and safety of inter-hospital ECMO transports for pediatric COVID-19 cases.
- To evaluate the risks to ECMO teams during these specialized transports.
Main Methods:
- Retrospective analysis of five consecutive pediatric ECMO transports for COVID-19 patients.
- Data collected via the EuroECMO COVID_Neo/Ped Survey between March 2020 and September 2021.
- Inclusion of data from 52 European neonatal and/or pediatric ECMO centers.
Main Results:
- Transports were conducted for pediatric ARDS and COVID-19-associated myocarditis.
- Successful transports with no major adverse events, despite varying distances (8-390 km) and durations (5-15 h).
- Hospital survival was 60%; one patient experienced neurological sequelae. No ECMO team members contracted COVID-19.
Conclusions:
- Inter-hospital ECMO transport for pediatric COVID-19 patients is feasible and safe when performed by experienced teams.
- These specialized transports pose minimal risk of transmission to healthcare personnel.
- Further research is needed to refine protocols and understand long-term outcomes.
Introduction:
ExtraCorporeal Membrane Oxygenation (ECMO) in pediatric patients with COVID-19 has a survival rate similar to adults. Occasionally, patients may need to be cannulated by an ECMO team in a referring hospital and transported to an ECMO center. The ECMO transport of a COVID-19 patient has additional risks than normal pediatric ECMO transport for the possible COVID-19 transmissibility to the ECMO team and the reduction of the ECMO team performance due to the need of wearing full personal protective equipment. Since pediatric data on ECMO transport of COVID-19 patients are lacking, we explored the outcomes of the pediatric COVID-19 ECMO transports collected in the EuroECMO COVID_Neo/Ped Survey.
Methods:
We reported five European consecutive ECMO transports of COVID-19 pediatric patients collected in the EuroECMO COVID_Neo/Ped Survey including 52 European neonatal and/or pediatric ECMO centers and endorsed by the EuroELSO from March 2020 till September 2021.
Results:
The ECMO transports were performed for two indications, pediatric ARDS and myocarditis associated to the multisystem inflammatory syndrome related to COVID-19. Cannulation strategies differed among patients according to the age of the patients, transport distance varied between 8 and 390 km with a total transport duration between 5 to 15 h. In all five cases, the ECMO transports were successfully performed without major adverse events. One patient reported a harlequin syndrome and another patient a cannula displacement both without major clinical consequences. Hospital survival was 60% with one patient reporting neurological sequelae. No ECMO team member developed COVID-19 symptoms after the transport.
Conclusion:
Five transports of pediatric patients with COVID-19 supported with ECMO were reported in the EuroECMO COVID_Neo/Ped Survey. All transports were performed by an experienced multidisciplinary ECMO team and were feasible and safe for both the patient and the ECMO team. Further experiences are needed to better characterize these transports and draw insightful conclusions.
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