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Extubated, Rehabilitation-Focused Extracorporeal Membrane Oxygenation for Pediatric Coronavirus Disease 2019: A Case
Kevin B Kilgallon1, Matthew Leroue2, Sara Shankman2
1From the Department of Pediatrics, Case Western University School of Medicine, Rainbow Babies and Children's Hospital, Cleveland, Ohio.
Insights
Pediatric COVID-19 patients on extracorporeal membrane oxygenation (ECMO) showed good outcomes with a rehabilitation strategy. Early extubation and mobility were achieved while on ECMO support, with most survivors regaining functional status.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Respiratory medicine
Background:
- Coronavirus 2019 (COVID-19) pandemic caused severe lung injury in children.
- Acute respiratory distress syndrome (ARDS) in pediatric COVID-19 cases often required extracorporeal membrane oxygenation (ECMO).
Purpose of the Study:
- To describe a center's experience with a rehabilitation-focused ECMO strategy.
- To evaluate outcomes of pediatric patients with acute COVID-19 pneumonia undergoing ECMO with early extubation.
Main Methods:
- Case series of four pediatric patients with acute COVID-19 pneumonia requiring ECMO.
- Implementation of a rehabilitation-focused ECMO strategy, including extubation during ECMO support.
- Monitoring of patient tolerance, mobility, ECMO duration, and hospital length of stay.
Main Results:
- All four patients tolerated extubation within 30 days of ECMO initiation.
- Patients achieved mobility while on ECMO support.
- Three of four patients survived; two survivors had normal functional status at discharge with ongoing respiratory support.
Conclusions:
- A rehabilitation-focused ECMO strategy is well-tolerated in pediatric COVID-19 patients.
- Early extubation and in-ECMO mobility can lead to favorable outcomes.
- This approach may improve functional status in critically ill children with severe COVID-19 pneumonia.
Abstract:
During the coronavirus 2019 (COVID-19) pandemic, children suffered severe lung injury resulting in acute respiratory distress syndrome requiring support with extracorporeal membrane oxygenation (ECMO). In this case series, we described our center's experience employing a rehabilitation-focused ECMO strategy including extubation during ECMO support in four pediatric patients with acute COVID-19 pneumonia hospitalized from September 2021 to January 2022. All four patients tolerated extubation within 30 days of ECMO initiation and achieved mobility while on ECMO support. Duration of ECMO support was 35-152 days and hospital lengths of stay were 52-167 days. Three of four patients survived. Two of three survivors had normal functional status at discharge except for ongoing respiratory support. The third survivor had significant motor deficits due to critical illness polyneuropathy and was supported with daytime oxygen and nocturnal noninvasive support. Overall, these patients demonstrated good outcomes and tolerance of a rehabilitation-focused ECMO strategy.
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