Journal article
Extracorporeal Membrane Oxygenation Characteristics and Outcomes in Children and Adolescents With COVID-19 or Multisystem Inflammatory Syndrome Admitted to U.S. ICUs
Pediatric critical care medicine, Vol.24(5), pp.356-371
05/2023
DOI: 10.1097/PCC.0000000000003212
PMCID: PMC10153593
PMID: 36995097
Abstract
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.
Case series of patients from the Overcoming COVID-19 public health surveillance registry.
Sixty-three hospitals in 32 U.S. states reporting to the registry between March 15, 2020, and December 31, 2021.
Patients less than 21 years admitted to the ICU meeting Centers for Disease Control criteria for MIS-C or acute COVID-19.
None.
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.
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.
Details
- Title: Subtitle
- Extracorporeal Membrane Oxygenation Characteristics and Outcomes in Children and Adolescents With COVID-19 or Multisystem Inflammatory Syndrome Admitted to U.S. ICUs
- Creators
- Melania M Bembea - Johns Hopkins University School of MedicineKari A Wellnitz - University of IowaLaura L Loftis - Baylor College of MedicineRavi R Thiagarajan - Boston Children's HospitalCameron C Young - Boston Children's HospitalTimothy P McCadden - Boston Children's HospitalMargaret M Newhams - Boston Children's HospitalSuden Kucukak - Boston Children's HospitalElizabeth H Mack - Medical University of South CarolinaJulie C Fitzgerald - Philadelphia UniversityCourtney M Rowan - Indiana UniversityAline B Maddux - Children's Hospital ColoradoAmanda R Kolmar - Washington University in St. LouisKatherine Irby - Arkansas Children's HospitalSabrina Heidemann - Central Michigan UniversityStephanie P Schwartz - University of North Carolina at Chapel HillMichele Kong - University of Alabama at BirminghamHillary Crandall - University of UtahKevin M Havlin - University of LouisvilleJennifer E Schuster - Sisters of Mercy Health SystemAalok R Singh - Maria Fareri Children's HospitalMark W Hall - Nationwide Children's HospitalMia Maamari - Department of Pediatrics, Division of Critical Care Medicine, University of Texas Southwestern, Children's Health Medical Center, Dallas, TXMary G Gaspers - University of ArizonaRyan A Nofziger - Akron Children's HospitalPeter Paul C Lim - Division of Pediatric Critical Care Medicine, Rainbow Babies and Children's Hospital, Cleveland, OHRyan W Carroll - Harvard Medical SchoolAlvaro Coronado Munoz - The University of Texas Health Science Center at HoustonTamara T Bradford - Louisiana State UniversityMelissa L Cullimore - Division of Pediatric Critical Care, Department of Pediatrics, Children's Hospital and Medical Center, Omaha, NENatasha B Halasa - Vanderbilt University Medical CenterGwenn E McLaughlin - University of MiamiPia S Pannaraj - Division of Infectious Diseases, Children's Hospital Los Angeles and Departments of Pediatrics and Molecular Microbiology and Immunology, University of Southern California, Los Angeles, CANatalie Z Cvijanovich - UCSF Benioff Children's HospitalMatt S Zinter - University of California, San FranciscoBria M Coates - Northwestern UniversitySteven M Horwitz - Rutgers, The State University of New JerseyCharlotte V Hobbs - University of Mississippi Medical CenterHeda Dapul - Department of Pediatrics, Division of Infectious Diseases, New York University Grossman School of Medicine and Hassenfeld Children's Hospital, New York, NYAna Lia Graciano - Department of Pediatrics, Division of Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MDAndrew D Butler - St. Christopher's Hospital for ChildrenManish M Patel - Centers for Disease Control and PreventionLaura D Zambrano - Centers for Disease Control and PreventionAngela P Campbell - Centers for Disease Control and PreventionAdrienne G Randolph - Harvard Medical SchoolOvercoming COVID-19 Investigators
- Resource Type
- Journal article
- Publication Details
- Pediatric critical care medicine, Vol.24(5), pp.356-371
- DOI
- 10.1097/PCC.0000000000003212
- PMID
- 36995097
- PMCID
- PMC10153593
- ISSN
- 1529-7535
- eISSN
- 1947-3893
- Language
- English
- Electronic publication date
- 03/30/2023
- Date published
- 05/2023
- Academic Unit
- Critical Care; Stead Family Department of Pediatrics
- Record Identifier
- 9984381025902771
Metrics
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