Extracorporeal membrane oxygenation in children with COVID-19 and PIMS-TS during the second and third wave

Nardo, Matteo Di; Piero, Maria Elena De; Hoskote, Aparna; Bělohlávek, Jan; Lorusso, Roberto; Thiruchelvam, Timothy; Lillie, Jon; Stanley, Vanessa; StJohn, Lorna; Amodeo, Antonio; Balcells, Joan; Hofheinz, Sylvia Belda; Abecasis, Francisco; Roncon‐Albuquerque, Roberto; Amigoni, Angela; Davidson, Mark; Longobardo, Annalisa; Maráczi, Veronika; Pollak, Uri; Cecchetti, Corrado; Villani, Alberto; Broman, Lars; Kneyber, Martin C. J.; Perz-Ortiz, Alba; Schaible, Thomas

doi:10.1016/s2352-4642(22)00065-7

Cited by 13 publications

(24 citation statements)

References 6 publications

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“…3 , http://links.lww.com/PCC/C260 ). The mortality rate of children who received venovenous-ECMO could not be calculated by a meta-analysis because only one study with two or more cases reported the mortality rate of patients on venovenous-ECMO ( 8 ). We thus calculated the mortality rate of patients on venovenous-ECMO by summation, which was 10.0% (2/20).…”

Section: Resultsmentioning

confidence: 99%

“…For the secondary outcomes, the successful weaning rate from ECMO and complications while on ECMO was reported in eight ( 8 , 9 , 11 , 13 , 20 , 21 , 23 , 24 ) and five ( 8 , 9 , 11 , 13 , 22 ) studies out of the 12, respectively. The successful weaning rate was estimated to be 77.0% (49/58; 95% CI, 55.4–90.1; I 2 = 33.5%) ( Fig.…”

Section: Resultsmentioning

confidence: 99%

“…The mortality and successful weaning rates reported in previous studies varied. Outcomes of ECMO can be affected by many factors, including the indication for ECMO, the severity of the COVID-19–related illness, the presence of underlying comorbidities, and complications during ECMO treatment ( 8 , 9 , 13 , 19 , 20 , 23 ). Although some observational studies highlighted the favorable outcomes of children receiving ECMO for COVID-19 with a 0% mortality rate ( 13 , 20 , 26 ), others reported no survival of children on ECMO ( 19 , 23 ).…”

Section: Discussionmentioning

confidence: 99%

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Extracorporeal Membrane Oxygenation in Children With COVID-19: A Systematic Review and Meta-Analysis*

Watanabe

Yasuhara

Karube

et al. 2022

Pediatric Critical Care Medicine

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OBJECTIVES: The indication, complications, and outcomes of extracorporeal membrane oxygenation (ECMO) in children with COVID-19–related illnesses remain unelucidated. Our study aimed to investigate the characteristics and outcomes of ECMO in children with COVID-19–related illnesses. DATA SOURCES: We searched PubMed and EMBASE databases in March 2022. STUDY SELECTION: We retrieved all studies involving children (age ≤ 18 yr) with COVID-19–related illnesses who received ECMO. DATA EXTRACTION: Two authors independently extracted data and assessed the risk of bias. Mortality, successful weaning rate, and complications while on ECMO were synthesized by a one-group meta-analysis using a random-effect model. Meta-regression was performed to explore the risk factors for mortality. DATA SYNTHESIS: We included 18 observational studies, four case series, and 22 case reports involving 110 children with COVID-19–related illnesses receiving ECMO. The median age was 8 years (range, 10 d to 18 yr), and the median body mass index was 21.4 kg/m 2 (range, 12.3–56.0 kg/m 2 ). The most common comorbidities were obesity (11% [7/63]) and congenital heart disease (11% [7/63]), whereas 48% (30/63) were previously healthy. The most common indications for ECMO were multisystem inflammatory syndrome in children (52% [47/90]) and severe acute respiratory distress syndrome (40% [36/90]). Seventy-one percent (56/79) received venoarterial-ECMO. The median ECMO runtime was 6 days (range, 3–51 d) for venoarterial ECMO and 11 days (range, 3–71 d) for venovenous ECMO. The mortality was 26.6% (95% CI, 15.9–40.9), and the successful weaning rate was 77.0% (95% CI, 55.4–90.1). Complications were seen in 37.0% (95% CI, 23.1–53.5) while on ECMO, including stroke, acute kidney injury, pulmonary edema, and thromboembolism. Corticosteroids and IV immunoglobulin therapies were associated with lower mortality. CONCLUSIONS: The mortality of children on ECMO for COVID-19 was relatively low. This invasive treatment can be considered as a treatment option for critically ill children with COVID-19.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Extracorporeal Membrane Oxygenation in Children With COVID-19: A Systematic Review and Meta-Analysis*

Watanabe

Yasuhara

Karube

et al. 2022

Pediatric Critical Care Medicine

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“…PARDS related to COVID-19 is not different from other etiologies of PARDS, therefore, the general principles of management and end goals of respiratory therapy are the same as other causes of PARDS [ 63 ]. Recent data suggest that patients with refractory hypoxemia or cardiogenic shock related to MIS-C may benefit from ECMO; however, precise ECMO indications remain unclear due to the limited number of patients treated so far [ 64 , 65 ]. Although these studies may be affected by publication bias, ECMO survival in PARDS-related to COVID-19 was higher than that of PARDS from other etiologies.…”

Section: Special Populationsmentioning

confidence: 99%

Extracorporeal membrane oxygenation for COVID-19-related acute respiratory distress syndrome: a narrative review

et al. 2023

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A growing body of evidence supports the use of extracorporeal membrane oxygenation (ECMO) for severe acute respiratory distress syndrome (ARDS) refractory to maximal medical therapy. ARDS may develop in a proportion of patients hospitalized for coronavirus disease 2019 (COVID-19) and ECMO may be used to manage patients refractory to maximal medical therapy to mitigate the risk of ventilator-induced lung injury and provide lung rest while awaiting recovery. The mortality of COVID-19-related ARDS was variously reassessed during the pandemic. Veno-venous (VV) ECMO was the default choice to manage refractory respiratory failure; however, with concomitant severe right ventricular dysfunction, venoarterial (VA) ECMO or mechanical right ventricular assist devices with extracorporeal gas exchange (Oxy-RVAD) were also considered. ECMO has also been used to manage special populations such as pregnant women, pediatric patients affected by severe forms of COVID-19, and, in cases with persistent and seemingly irreversible respiratory failure, as a bridge to successful lung transplantation. In this narrative review, we outline and summarize the most recent evidence that has emerged on ECMO use in different patient populations with COVID-19-related ARDS.

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“…Another rare post-infectious pediatric complication of SARS-CoV-2 is multisystem inflammatory syndrome in children (MIS-C) which can rapidly progress to cardiac dysfunction and/or shock ( 1 ). Although most children who require admission to an ICU with severe COVID-19 or MIS-C survive and are discharged home ( 2 , 3 , 6 , 7 ), some children with severe cardiac or respiratory failure require extracorporeal membrane oxygenation (ECMO) ( 8 , 9 ).…”

mentioning

confidence: 99%

Extracorporeal Membrane Oxygenation Characteristics and Outcomes in Children and Adolescents With COVID-19 or Multisystem Inflammatory Syndrome Admitted to U.S. ICUs*

Bembea

Loftis

Thiagarajan

et al. 2023

Pediatric Critical Care Medicine

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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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Extracorporeal membrane oxygenation in children with COVID-19 and PIMS-TS during the second and third wave

Cited by 13 publications

References 6 publications

Extracorporeal Membrane Oxygenation in Children With COVID-19: A Systematic Review and Meta-Analysis*

Extracorporeal Membrane Oxygenation in Children With COVID-19: A Systematic Review and Meta-Analysis*

Extracorporeal membrane oxygenation for COVID-19-related acute respiratory distress syndrome: a narrative review

Extracorporeal Membrane Oxygenation Characteristics and Outcomes in Children and Adolescents With COVID-19 or Multisystem Inflammatory Syndrome Admitted to U.S. ICUs*

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