tetano
Editor, Senior Moderator
Pediatr Crit Care Med
. 2023 Mar 30.
doi: 10.1097/PCC.0000000000003212. Online ahead of print.
Extracorporeal Membrane Oxygenation Characteristics and Outcomes in Children and Adolescents With COVID-19 or Multisystem Inflammatory Syndrome Admitted to U.S. ICUs
Melania M Bembea[SUP] 1 [/SUP], Laura L Loftis[SUP] 2 [/SUP], Ravi R Thiagarajan[SUP] 3 [/SUP], Cameron C Young[SUP] 4 [/SUP], Timothy P McCadden[SUP] 4 [/SUP], Margaret M Newhams[SUP] 4 [/SUP], Suden Kucukak[SUP] 4 [/SUP], Elizabeth H Mack[SUP] 5 [/SUP], Julie C Fitzgerald[SUP] 6 [/SUP], Courtney M Rowan[SUP] 7 [/SUP], Aline B Maddux[SUP] 8 [/SUP], Amanda R Kolmar[SUP] 9 [/SUP], Katherine Irby[SUP] 10 [/SUP], Sabrina Heidemann[SUP] 11 [/SUP], Stephanie P Schwartz[SUP] 12 [/SUP], Michele Kong[SUP] 13 [/SUP], Hillary Crandall[SUP] 14 [/SUP], Kevin M Havlin[SUP] 15 [/SUP], Aalok R Singh[SUP] 16 [/SUP], Jennifer E Schuster[SUP] 17 [/SUP], Mark W Hall[SUP] 18 [/SUP], Kari A Wellnitz[SUP] 19 [/SUP], Mia Maamari[SUP] 20 [/SUP], Mary G Gaspers[SUP] 21 [/SUP], Ryan A Nofziger[SUP] 22 [/SUP], Peter Paul C Lim[SUP] 23 [/SUP], Ryan W Carroll[SUP] 24 [/SUP], Alvaro Coronado Munoz[SUP] 25 [/SUP], Tamara T Bradford[SUP] 26 [/SUP], Melissa L Cullimore[SUP] 27 [/SUP], Natasha B Halasa[SUP] 28 [/SUP], Gwenn E McLaughlin[SUP] 29 [/SUP], Pia S Pannaraj[SUP] 30 [/SUP], Natalie Z Cvijanovich[SUP] 31 [/SUP], Matt S Zinter[SUP] 32 [/SUP], Bria M Coates[SUP] 33 [/SUP], Steven M Horwitz[SUP] 34 [/SUP], Charlotte V Hobbs[SUP] 35 [/SUP], Heda Dapul[SUP] 36 [/SUP], Ana Lia Graciano[SUP] 37 [/SUP], Andrew D Butler[SUP] 38 [/SUP], Manish M Patel[SUP] 39 [/SUP], Laura D Zambrano[SUP] 39 [/SUP], Angela P Campbell[SUP] 39 [/SUP], Adrienne G Randolph[SUP] 4 40 [/SUP]; Overcoming COVID-19 Investigators
Collaborators, Affiliations
Abstract
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.
. 2023 Mar 30.
doi: 10.1097/PCC.0000000000003212. Online ahead of print.
Extracorporeal Membrane Oxygenation Characteristics and Outcomes in Children and Adolescents With COVID-19 or Multisystem Inflammatory Syndrome Admitted to U.S. ICUs
Melania M Bembea[SUP] 1 [/SUP], Laura L Loftis[SUP] 2 [/SUP], Ravi R Thiagarajan[SUP] 3 [/SUP], Cameron C Young[SUP] 4 [/SUP], Timothy P McCadden[SUP] 4 [/SUP], Margaret M Newhams[SUP] 4 [/SUP], Suden Kucukak[SUP] 4 [/SUP], Elizabeth H Mack[SUP] 5 [/SUP], Julie C Fitzgerald[SUP] 6 [/SUP], Courtney M Rowan[SUP] 7 [/SUP], Aline B Maddux[SUP] 8 [/SUP], Amanda R Kolmar[SUP] 9 [/SUP], Katherine Irby[SUP] 10 [/SUP], Sabrina Heidemann[SUP] 11 [/SUP], Stephanie P Schwartz[SUP] 12 [/SUP], Michele Kong[SUP] 13 [/SUP], Hillary Crandall[SUP] 14 [/SUP], Kevin M Havlin[SUP] 15 [/SUP], Aalok R Singh[SUP] 16 [/SUP], Jennifer E Schuster[SUP] 17 [/SUP], Mark W Hall[SUP] 18 [/SUP], Kari A Wellnitz[SUP] 19 [/SUP], Mia Maamari[SUP] 20 [/SUP], Mary G Gaspers[SUP] 21 [/SUP], Ryan A Nofziger[SUP] 22 [/SUP], Peter Paul C Lim[SUP] 23 [/SUP], Ryan W Carroll[SUP] 24 [/SUP], Alvaro Coronado Munoz[SUP] 25 [/SUP], Tamara T Bradford[SUP] 26 [/SUP], Melissa L Cullimore[SUP] 27 [/SUP], Natasha B Halasa[SUP] 28 [/SUP], Gwenn E McLaughlin[SUP] 29 [/SUP], Pia S Pannaraj[SUP] 30 [/SUP], Natalie Z Cvijanovich[SUP] 31 [/SUP], Matt S Zinter[SUP] 32 [/SUP], Bria M Coates[SUP] 33 [/SUP], Steven M Horwitz[SUP] 34 [/SUP], Charlotte V Hobbs[SUP] 35 [/SUP], Heda Dapul[SUP] 36 [/SUP], Ana Lia Graciano[SUP] 37 [/SUP], Andrew D Butler[SUP] 38 [/SUP], Manish M Patel[SUP] 39 [/SUP], Laura D Zambrano[SUP] 39 [/SUP], Angela P Campbell[SUP] 39 [/SUP], Adrienne G Randolph[SUP] 4 40 [/SUP]; Overcoming COVID-19 Investigators
Collaborators, Affiliations
- PMID: 36995097
- DOI: 10.1097/PCC.0000000000003212
Abstract
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.